Provider Demographics
NPI:1093532301
Name:NUEVA CREACION DE DIOS
Entity type:Organization
Organization Name:NUEVA CREACION DE DIOS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:OFELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:NERI
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:323-434-5710
Mailing Address - Street 1:611 HARDING AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90022
Mailing Address - Country:US
Mailing Address - Phone:323-434-5710
Mailing Address - Fax:
Practice Address - Street 1:4270 ACACIA AVE PICO RIVERA CA 90660
Practice Address - Street 2:4311 OLANDA ST
Practice Address - City:LYNWOOD
Practice Address - State:CA
Practice Address - Zip Code:92062
Practice Address - Country:US
Practice Address - Phone:323-434-5710
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-26
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty