Provider Demographics
NPI:1740055078
Name:RESURRECCION, ASHLEY ABIGAIL GRUEZO
Entity type:Individual
Prefix:
First Name:ASHLEY ABIGAIL
Middle Name:GRUEZO
Last Name:RESURRECCION
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 1:7025 WOODMAN AVE APT 12A
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405-3426
Mailing Address - Country:US
Mailing Address - Phone:818-988-8865
Mailing Address - Fax:
Practice Address - Street 1:7025 WOODMAN AVE APT 12A
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-3426
Practice Address - Country:US
Practice Address - Phone:818-988-8865
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-16
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAPCC14047101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor