Basic Information
| Provider Information | |||||||||
| NPI: | 1316419591 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SU HU | ||||||||
| FirstName: | RITA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1509 W CAMERON AVE STE 230 | ||||||||
| Address2: | |||||||||
| City: | WEST COVINA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917902725 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6269933000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1509 W CAMERON AVE STE 230 | ||||||||
| Address2: | |||||||||
| City: | WEST COVINA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917902725 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6269933070 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/27/2018 | ||||||||
| LastUpdateDate: | 01/07/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 110151 | CA | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 106H00000X | 130092 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.