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General NPI Number Information
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NPI Number | 1760944227
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Entity Type | Organization
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Legal Business Name | VIDA WHOLENESS FAMILY THERAPY CORP
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Dates
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Enumeration Date | 04/03/2019
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Last Update Date | 02/15/2023
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Provider Practice Location Address
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Address Line | 1875 W REDONDO BEACH BLVD STE 303
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City | GARDENA
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State | CA
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Zip | 90247-3644
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Country | US
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Telephone | 424-262-2099
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Fax |
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Provider Business Mailing Address
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Address Line | 8050 FLORENCE AVE STE 32
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City | DOWNEY
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State | CA
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Zip | 90240-3896
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Country | US
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Telephone | 424-262-2099
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MARIBEL GUERRA
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Credential | LCSW
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Telephone | 424-262-2099
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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