Provider Demographics
NPI:1073386827
Name:CALIFORNA PSYCHOSOCIAL GROUP INC
Entity Type:Organization
Organization Name:CALIFORNA PSYCHOSOCIAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:ANA
Authorized Official - Middle Name:ROSA
Authorized Official - Last Name:ASCENCIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-219-8054
Mailing Address - Street 1:4858 W PICO BLVD STE 718
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90019-4225
Mailing Address - Country:US
Mailing Address - Phone:310-622-5256
Mailing Address - Fax:
Practice Address - Street 1:1435 S VERMONT AVE STE 100
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-4543
Practice Address - Country:US
Practice Address - Phone:213-386-2511
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-02
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty