Basic Information
| Provider Information | |||||||||
| NPI: | 1609174077 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CUESTAS | ||||||||
| FirstName: | ADRIANA | ||||||||
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| Credential: | MA, MFTI, PSYD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 251664 | ||||||||
| Address2: | |||||||||
| City: | GLENDALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 912251664 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3109779043 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2121 W TEMPLE ST | ||||||||
| Address2: | 425 LAKE STREET | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900264915 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2133855100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/08/2011 | ||||||||
| LastUpdateDate: | 03/02/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225C00000X | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Rehabilitation Counselor | 103TC0700X | 29921 | CA | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.