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Organization
SELF
Active
Organization
SELF
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARIA NIEVES ORNELAS (LCSW)
(818) 263-7904
Entity
Organization
Contact information
Practice address
10136 AMIGO AVE, NORTHRIDGE, CA 91324-1301
(818) 263-7904
Mailing address
10136 AMIGO AVE, NORTHRIDGE, CA 91324-1301
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
LCS 20834
CA
Other
Enumeration date
11/15/2012
Last updated
11/15/2012
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