Provider Demographics
NPI:1386450690
Name:ST. ANNE'S
Entity type:Organization
Organization Name:ST. ANNE'S
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL AND ADMINISTRATIVE SITE SU
Authorized Official - Prefix:
Authorized Official - First Name:JACPUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAVALA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:323-381-2931
Mailing Address - Street 1:155 N OCCIDENTAL BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90026-4641
Mailing Address - Country:US
Mailing Address - Phone:213-760-6987
Mailing Address - Fax:
Practice Address - Street 1:155 N OCCIDENTAL BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90026-4641
Practice Address - Country:US
Practice Address - Phone:213-812-9313
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-10
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt TherapistGroup - Multi-Specialty