Jacqueline Lizzette Azucena
Individual provider Active NPI Clinical Social Worker · Los Angeles, CA
NPI 1508146325 · NPPES record last updated Mar 16, 2022
Key facts
- NPI
- 1508146325
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 75725 (CA)
- Practice address
- 515 E 6TH St
Los Angeles, CA 90021-1009 - Phone
- (562) 867-7999
- NPI assigned
- Aug 24, 2011
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 4
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210324002656 | CA | Practitioner - Clinical Social Worker | 7911314604 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 75725 | CA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Adelante Therapy | Clinical | Current |
Accepting new patients |
| JWCH Institute Inc | Current |
Accepting new patients | |
| JWCH Institute Inc | Current |
Accepting new patients | |
| Foothill Family Service | Past | Accepting new patients |
Locations
5800 S Eastern Ave
Ste 500
Commerce, CA 90040
Phone (323) 308-9397
5650 Jillson St
Commerce, CA 90040
Phone (213) 484-1186
522 S San Pedro St
Los Angeles, CA 90013
Phone (213) 486-4085
515 E 6th St
Los Angeles, CA 90021
Phone (213) 529-0963
12360 Firestone Blvd
Norwalk, CA 90650
Phone (562) 281-0305
Interoperability endpoints
- jacqueline.azucenalcsw.p1@direct.jwch.nextgenshare.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 75725 | CA | Yes |
Addresses
Primary practice location
515 E 6TH St
Los Angeles, CA 90021-1009
Mailing address
515 E 6TH St
Los Angeles, CA 90021-1009
Other providers in Los Angeles, CA
- Lea Azour
- Samantha Azriel
- Ugochi Onuchi Azubuike
- Mercy Ekeoma Azubuko-Udah
- Daniel Orlando Azucar
- Neil Lomeda Azul
- Gabriella Azzam-Forni
- Huda Azzam
- Ramzi I Azzam
- Shadera Azzam
All providers in Los Angeles, CA · Clinical Social Worker in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 16, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.