Healthcare Provider Details

I. General information

NPI: 1467990804
Provider Name (Legal Business Name): EDITH CONTRERAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EDITH MEDINA

II. Dates (important events)

Enumeration Date: 02/06/2017
Last Update Date: 09/16/2022
Certification Date: 09/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10155 COLIMA RD
WHITTIER CA
90603-2042
US

IV. Provider business mailing address

10155 COLIMA RD
WHITTIER CA
90603-2042
US

V. Phone/Fax

Practice location:
  • Phone: 562-692-0383
  • Fax: 562-692-0380
Mailing address:
  • Phone: 562-692-0383
  • Fax: 562-692-0380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2928
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberAPCC11553
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: