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General NPI Number Information
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NPI Number | 1629892849
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Entity Type | Organization
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Legal Business Name | TETRAWAVE
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Dates
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Enumeration Date | 11/13/2024
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Last Update Date | 11/13/2024
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Provider Practice Location Address
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Address Line | 10031 HASKELL AVE
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City | NORTH HILLS
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State | CA
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Zip | 91343-1505
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Country | US
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Telephone | 562-208-7216
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Fax |
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Provider Business Mailing Address
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Address Line | 30 N GOULD ST # 44162
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City | SHERIDAN
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State | WY
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Zip | 82801-6317
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Country | US
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Telephone | 562-208-7216
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Fax |
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Authorized Official
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Title or Position | COO
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Name | CHRISTIAN CASTANEDA
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Credential | LCSW
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Telephone | 562-207-7216
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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 |
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License Number State |
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