Basic Information
| Provider Information | |||||||||
| NPI: | 1235365164 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DE ARAGON | ||||||||
| FirstName: | DAVID | ||||||||
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| NameSuffix: | JR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 370 CRENSHAW BLVD # 100 | ||||||||
| Address2: | |||||||||
| City: | TORRANCE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 905031727 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3108087482 | ||||||||
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| Practice Location | |||||||||
| Address1: | 161 W VICTORIA ST | ||||||||
| Address2: | |||||||||
| City: | LONG BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 908052175 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3232425000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2009 | ||||||||
| LastUpdateDate: | 06/26/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 59601 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.