Provider Demographics
NPI:1619426145
Name:NUESTRA FAMILIA, A COUNSELING AND SOCIAL SERVICES AGENCY, INC
Entity Type:Organization
Organization Name:NUESTRA FAMILIA, A COUNSELING AND SOCIAL SERVICES AGENCY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARICELA
Authorized Official - Middle Name:
Authorized Official - Last Name:CALATAYUD
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:626-487-5483
Mailing Address - Street 1:163 S AVENUE 24 STE 201
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90031-2299
Mailing Address - Country:US
Mailing Address - Phone:855-932-6454
Mailing Address - Fax:855-932-6454
Practice Address - Street 1:163 S AVENUE 24 STE 201
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90031-2299
Practice Address - Country:US
Practice Address - Phone:855-932-6454
Practice Address - Fax:855-932-6454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-26
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS147051041C0700X
133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty