Basic Information
| Provider Information | |||||||||
| NPI: | 1952691297 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CALLEJA | ||||||||
| FirstName: | LIDIA | ||||||||
| MiddleName: | VICTORIA | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | I | ||||||||
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| Mailing Information | |||||||||
| Address1: | 470 E 3RD ST STE C | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900131630 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2136205712 | ||||||||
| FaxNumber: | 2136214155 | ||||||||
| Practice Location | |||||||||
| Address1: | 4099 N MISSION RD | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90032 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3232211746 | ||||||||
| FaxNumber: | 3232215176 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/07/2011 | ||||||||
| LastUpdateDate: | 05/22/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 171M00000X | Y | Other Service Providers | Case Manager/Care Coordinator |
No ID Information.