Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | 90714 | CA |
N | 1041C0700X | Clinical Social Worker | ||
N | 225C00000X | Rehabilitation Counselor |
NPI | 1295493518 |
---|---|
Provider Name | Liliana Gandarilla |
First Address | Los Angeles, CA 90026 |
Second Address | Los Angeles, CA 90026 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/12/2021 |
Last Update Date | 07/12/2021 |