Provider Demographics
NPI:1104417617
Name:AVANZA FAMILY SERVICES INCORPORATED
Entity type:Organization
Organization Name:AVANZA FAMILY SERVICES INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CESAR
Authorized Official - Middle Name:
Authorized Official - Last Name:JASS
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:310-346-1019
Mailing Address - Street 1:6510 LA MIRADA AVE APT 305
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90038-1465
Mailing Address - Country:US
Mailing Address - Phone:310-346-1019
Mailing Address - Fax:323-798-4416
Practice Address - Street 1:4325 W SUNSET BLVD STE 209
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90029-2180
Practice Address - Country:US
Practice Address - Phone:310-878-2599
Practice Address - Fax:323-798-4416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-27
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty