Basic Information
| Provider Information | |||||||||
| NPI: | 1356936157 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DELATORRE | ||||||||
| FirstName: | SHAWNA | ||||||||
| MiddleName: | ALEXANDRA | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | AMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 36949 FRANKLIN AVE | ||||||||
| Address2: | |||||||||
| City: | MADERA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 936368210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5595142610 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1470 W HERNDON AVE # 300 | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937110552 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5592562000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/03/2021 | ||||||||
| LastUpdateDate: | 03/30/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/30/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | AMFT122765 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.