=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306419387
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALICIA ORTENCIA CARRANZA MCHES, NBC-HWC, CTSS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/19/2021
-----------------------------------------------------
Last Update Date | 05/12/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 600 N ATLANTIC BLVD APT 510
-----------------------------------------------------
City | MONTEREY PARK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91754-7753
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-284-6770
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 245 W GARVEY AVE UNIT 978
-----------------------------------------------------
City | MONTEREY PARK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91754-9445
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-284-6770
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171400000X
-----------------------------------------------------
Taxonomy Name | Health & Wellness Coach
-----------------------------------------------------
License Number | 24253
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------