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General NPI Number Information
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NPI Number | 1639518939
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Entity Type | Individual
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Provider Name | TANYA LIQUIDANO
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Gender | Female
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Dates
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Enumeration Date | 06/19/2013
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Last Update Date | 07/09/2020
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Provider Practice Location Address
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Address Line | 1720 E 120TH ST
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City | LOS ANGELES
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State | CA
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Zip | 90059-3052
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Country | US
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Telephone | 310-668-4272
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 29371
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City | LOS ANGELES
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State | CA
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Zip | 90029-0371
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Country | US
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Telephone | 310-668-3423
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Fax | 310-668-3452
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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 | 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 |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | ASW 64525
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | ASW 64525
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 225400000X
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Taxonomy Name | Rehabilitation Practitioner
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCSW88680
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License Number State | CA
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