Provider Demographics
NPI:1922359413
Name:ITEN, LETICIA
Entity Type:Individual
Prefix:
First Name:LETICIA
Middle Name:
Last Name:ITEN
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:PO BOX 513
Mailing Address - Street 2:
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92244-0513
Mailing Address - Country:US
Mailing Address - Phone:760-353-6571
Mailing Address - Fax:760-353-6281
Practice Address - Street 1:444 S 8TH ST STE B3
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-3236
Practice Address - Country:US
Practice Address - Phone:760-353-6571
Practice Address - Fax:760-353-6281
Is Sole Proprietor?:No
Enumeration Date:2012-09-25
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW86884104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker