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General NPI Number Information
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NPI Number | 1871061374
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Entity Type | Individual
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Provider Name | ELA BARREDO BICO
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Gender | Female
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Dates
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Enumeration Date | 11/02/2018
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Last Update Date | 11/02/2018
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Provider Practice Location Address
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Address Line | 679 S NEW HAMPSHIRE AVE
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City | LOS ANGELES
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State | CA
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Zip | 90005-1355
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Country | US
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Telephone | 626-254-5010
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Fax |
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Provider Business Mailing Address
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Address Line | 12816 FINCHLEY ST
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City | BALDWIN PARK
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State | CA
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Zip | 91706-3623
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Country | US
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Telephone | 626-549-9788
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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 | 167G00000X
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Taxonomy Name | Licensed Psychiatric Technician
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License Number | 33820
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License Number State | CA
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