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11616 Hawthorne Blvd Suite 202 Hawthorne CA 90250-2366 | |
| (323) 515-2628 | |
| (310) 674-4909 |
| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 11616 Hawthorne Blvd, Hawthorne, California |
| Authorized Official Name and Position | Rolando Ross (DIRECTOR) |
| Authorized Official Contact | 3235152628 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
11616 Hawthorne Blvd Suite 202 Hawthorne CA 90250-2366 Ph: (323) 515-2628 | 11616 Hawthorne Blvd Suite 202 Hawthorne CA 90250-2366 Ph: (323) 515-2628 |
| NPI Number | 1225447501 |
|---|---|
| Provider Enumeration Date | 08/12/2014 |
| Last Update Date | 08/12/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225447501 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 18585 (California) | Primary |
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