Provider Demographics
NPI:1306305479
Name:CEJAACOSTA, LOURDES
Entity type:Individual
Prefix:
First Name:LOURDES
Middle Name:
Last Name:CEJAACOSTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13502 WHITTIER BLVD # H145
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90605-1945
Mailing Address - Country:US
Mailing Address - Phone:562-322-2415
Mailing Address - Fax:
Practice Address - Street 1:18000 STUDEBAKER RD STE 700
Practice Address - Street 2:
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-2684
Practice Address - Country:US
Practice Address - Phone:562-322-2415
Practice Address - Fax:207-209-7681
Is Sole Proprietor?:No
Enumeration Date:2019-03-18
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12153567103K00000X
CA1-21-53567103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst