Healthcare Provider Details

I. General information

NPI: 1780432120
Provider Name (Legal Business Name): ALIA RENEE GRIFFIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2024
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4880 MARKET ST
VENTURA CA
93003-7783
US

IV. Provider business mailing address

2605 PERIWINKLE DR
SAN BERNARDINO CA
92407-2287
US

V. Phone/Fax

Practice location:
  • Phone: 310-337-7827
  • Fax: 310-337-7840
Mailing address:
  • Phone: 909-206-7200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW140314
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: