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General NPI Number Information
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NPI Number | 1538635354
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Entity Type | Individual
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Provider Name | MS. HEIDI MARGARITA CASANOVA
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Gender | Female
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Dates
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Enumeration Date | 10/18/2018
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Last Update Date | 01/07/2025
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Provider Practice Location Address
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Address Line | 840 N AVENUE 66
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City | LOS ANGELES
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State | CA
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Zip | 90042-1508
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Country | US
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Telephone | --
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Fax |
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Provider Business Mailing Address
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Address Line | 170 E. COLLEGE ST., PO BOX 5071
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City | COVINA
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State | CA
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Zip | 91723-5071
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Country | US
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Telephone |
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | AMFT15118
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License Number State | CA
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