Healthcare Provider Details

I. General information

NPI: 1184249955
Provider Name (Legal Business Name): PRISCILLA DOLOKSARIBU LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2020
Last Update Date: 12/18/2023
Certification Date: 12/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5300 ANGELES VISTA BLVD
VIEW PARK CA
90043-1648
US

IV. Provider business mailing address

701 S HOBART BLVD APT 202
LOS ANGELES CA
90005-2856
US

V. Phone/Fax

Practice location:
  • Phone: 323-295-4555
  • Fax:
Mailing address:
  • Phone: 909-733-2070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number119351
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: