Basic Information
Provider Information | |||||||||
NPI: | 1407002397 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | TOVAR | ||||||||
FirstName: | LIDIA | ||||||||
MiddleName: |   | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | L.C.S.W | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 8526 1/2 ROSE ST | ||||||||
Address2: |   | ||||||||
City: | BELLFLOWER | ||||||||
State: | CA | ||||||||
PostalCode: | 907066323 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5622465700 | ||||||||
FaxNumber: | 5622465701 | ||||||||
Practice Location | |||||||||
Address1: | 21520 PIONEER BLVD | ||||||||
Address2: | SUITE 110 | ||||||||
City: | HAWAIIAN GARDENS | ||||||||
State: | CA | ||||||||
PostalCode: | 907162603 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5628653644 | ||||||||
FaxNumber: | 5628655244 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/12/2008 | ||||||||
LastUpdateDate: | 10/11/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 10/11/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 61435 | CA | Y |   | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.