# SELF

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1699019786
- **Authorized official:** MARIA NIEVES ORNELAS (LCSW)
- **Authorized official phone:** (818) 263-7904

## Contact information

- **Practice address:** 10136 AMIGO AVE, NORTHRIDGE, CA 91324-1301
- **Practice address phone:** (818) 263-7904
- **Mailing address:** 10136 AMIGO AVE, NORTHRIDGE, CA 91324-1301

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 302R00000X | Health Maintenance Organization | LCS 20834 | CA | Yes |

## Other

- **Enumeration date:** 11/15/2012
- **Last updated:** 11/15/2012