Provider Demographics
NPI:1427310010
Name:RETA, STEFANIA MARIA
Entity type:Individual
Prefix:
First Name:STEFANIA
Middle Name:MARIA
Last Name:RETA
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 1:701 SAN ANGELO AVE
Mailing Address - Street 2:
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-3715
Mailing Address - Country:US
Mailing Address - Phone:323-327-7439
Mailing Address - Fax:
Practice Address - Street 1:510 S VERMONT AVE FL 20
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90020-1912
Practice Address - Country:US
Practice Address - Phone:323-327-7439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-11
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT102478106H00000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7368OtherMEDI-CAL
CA7667OtherMEDI-CAL
CA7184OtherMEDI-CAL
CA7708OtherMEDI-CAL