Provider Demographics
NPI:1316186349
Name:PRASOMSRI, DARUNEE
Entity Type:Individual
Prefix:
First Name:DARUNEE
Middle Name:
Last Name:PRASOMSRI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 E BIXBY RD
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-3432
Mailing Address - Country:US
Mailing Address - Phone:562-719-5290
Mailing Address - Fax:562-719-5261
Practice Address - Street 1:324 E BIXBY RD
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-3432
Practice Address - Country:US
Practice Address - Phone:562-719-9250
Practice Address - Fax:562-719-9261
Is Sole Proprietor?:No
Enumeration Date:2009-02-15
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
CA64262106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator