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General NPI Number Information
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NPI Number | 1710849468
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Entity Type | Organization
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Legal Business Name | COMMUNITY EVOLUTION ACQUISITION
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Dates
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Enumeration Date | 12/02/2025
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Last Update Date | 12/02/2025
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Provider Practice Location Address
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Address Line | 1767 VALLECITO DR
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City | SAN PEDRO
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State | CA
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Zip | 90732-4245
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Country | US
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Telephone | 424-503-3336
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Fax |
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Provider Business Mailing Address
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Address Line | 1767 VALLECITO DR
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City | SAN PEDRO
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State | CA
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Zip | 90732-4245
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Country | US
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Telephone | 424-503-3336
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | TIA LOPEZ
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Credential | BACHELORS SOCIAL W
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Telephone | 424-503-3336
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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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 | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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