Healthcare Provider Details

I. General information

NPI: 1407186588
Provider Name (Legal Business Name): ERNEST EFAH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2010
Last Update Date: 07/10/2023
Certification Date: 07/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11731 TELEGRAPH RD
SANTA FE SPRINGS CA
90670-3675
US

IV. Provider business mailing address

11731 TELEGRAPH RD STE G
SANTA FE SPRINGS CA
90670-6819
US

V. Phone/Fax

Practice location:
  • Phone: 562-942-8256
  • Fax: 562-949-3587
Mailing address:
  • Phone: 562-942-8256
  • Fax: 562-949-3587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberASW97070
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberASW97070
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: