Healthcare Provider Details

I. General information

NPI: 1396371126
Provider Name (Legal Business Name): JACQUELINE LOERA ASW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2020
Last Update Date: 02/25/2026
Certification Date: 02/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18780 AMAR RD STE 204
WALNUT CA
91789-4559
US

IV. Provider business mailing address

900 CORPORATE CENTER DR
MONTEREY PARK CA
91754-7620
US

V. Phone/Fax

Practice location:
  • Phone: 626-418-0622
  • Fax:
Mailing address:
  • Phone: 323-526-4016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number136885
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: