Healthcare Provider Details

I. General information

NPI: 1235978891
Provider Name (Legal Business Name): AJENAE LA'ZAE BURLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2024
Last Update Date: 05/23/2024
Certification Date: 05/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21600 OXNARD STREET SUITE 200
WOODLAND HILLS CA
91367
US

IV. Provider business mailing address

21600 OXNARD STREET SUITE 200
WOODLAND HILLS CA
91367
US

V. Phone/Fax

Practice location:
  • Phone: 877-206-1009
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: