Healthcare Provider Details

I. General information

NPI: 1356603443
Provider Name (Legal Business Name): CRISTIAN V ALCALA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CRISTIAN VIRIDIANA MARTINEZ LCSW

II. Dates (important events)

Enumeration Date: 06/13/2012
Last Update Date: 09/26/2023
Certification Date: 07/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13675 LINFIELD AVE
SYLMAR CA
91342-3309
US

IV. Provider business mailing address

13675 LINFIELD AVE
SYLMAR CA
91342-3309
US

V. Phone/Fax

Practice location:
  • Phone: 818-599-5458
  • Fax: 323-254-9087
Mailing address:
  • Phone: 626-324-9057
  • Fax: 323-254-9087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW99155
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: