Healthcare Provider Details

I. General information

NPI: 1043158918
Provider Name (Legal Business Name): SAN FERNANDO YOUTH ORGANIZATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2026
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12606 BROMONT AVE
SAN FERNANDO CA
91340-1204
US

IV. Provider business mailing address

12606 BROMONT AVE
SAN FERNANDO CA
91340-1204
US

V. Phone/Fax

Practice location:
  • Phone: 818-791-5230
  • Fax:
Mailing address:
  • Phone: 818-791-5230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH MAYA
Title or Position: FOUNDER & EXECUTIVE DIRECTOR
Credential: NA
Phone: 818-791-5230