Healthcare Provider Details

I. General information

NPI: 1114057999
Provider Name (Legal Business Name): MRS. MARIA EUGENIA LONG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 FAIR OAKS AVE
SOUTH PASADENA CA
91030-2630
US

IV. Provider business mailing address

1413 S MARENGO AVE
PASADENA CA
91106-4227
US

V. Phone/Fax

Practice location:
  • Phone: 626-831-4434
  • Fax:
Mailing address:
  • Phone: 626-441-4311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: