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General NPI Number Information
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NPI Number | 1245360114
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Entity Type | Individual
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Provider Name | MARICELA JAUREGUI
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Gender | Female
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Dates
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Enumeration Date | 03/07/2007
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Last Update Date | 12/15/2021
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Provider Practice Location Address
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Address Line | 1260 S SOTO ST STE 15
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City | LOS ANGELES
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State | CA
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Zip | 90023-2631
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Country | US
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Telephone | 323-695-5707
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Fax |
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Provider Business Mailing Address
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Address Line | 3900 E PACIFIC COAST HWY
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City | LONG BEACH
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State | CA
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Zip | 90804-2013
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Country | US
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Telephone | 323-695-5707
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 73929
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License Number State | CA
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