Provider Demographics
NPI:1316784820
Name:SOL Y SOMBRA LICENSED CLINICAL SOCIAL WORKER INC.
Entity type:Organization
Organization Name:SOL Y SOMBRA LICENSED CLINICAL SOCIAL WORKER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PSYCHOTHERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:LUATANI
Authorized Official - Middle Name:
Authorized Official - Last Name:FLORES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:323-505-2457
Mailing Address - Street 1:1225 CYPRESS AVE
Mailing Address - Street 2:STE 3 V411
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90065
Mailing Address - Country:US
Mailing Address - Phone:323-505-2457
Mailing Address - Fax:
Practice Address - Street 1:1225 CYPRESS AVE
Practice Address - Street 2:STE 3 V411
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90065
Practice Address - Country:US
Practice Address - Phone:323-505-2457
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-11
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty