Healthcare Provider Details

I. General information

NPI: 1053019638
Provider Name (Legal Business Name): ENLIGHTENING HEALTH SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2023
Last Update Date: 03/03/2025
Certification Date: 03/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

832 E CAMERON AVE
WEST COVINA CA
91790-4219
US

IV. Provider business mailing address

832 E CAMERON AVE
WEST COVINA CA
91790-4219
US

V. Phone/Fax

Practice location:
  • Phone: 213-309-8822
  • Fax:
Mailing address:
  • Phone: 213-309-8822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: RAN REN
Title or Position: OWNER
Credential: LCSW
Phone: 213-309-8822