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879 W 190th St Ste 400 Gardena CA 90248-4223 | |
| (818) 232-2959 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 879 W 190th St Ste 400, Gardena, California |
| Authorized Official Name and Position | Vakhtang Nazaryan (CEO) |
| Authorized Official Contact | 8182322959 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
879 W 190th St Ste 400 Gardena CA 90248-4223 Ph: () - | 879 W 190th St Ste 400 Gardena CA 90248-4223 Ph: (818) 232-2959 |
| NPI Number | 1134731011 |
|---|---|
| Provider Enumeration Date | 08/20/2020 |
| Last Update Date | 11/17/2021 |
| Certification Date | 11/17/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134731011 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| 252Y00000X | Early Intervention Provider Agency | (* (Not Available)) | Secondary |
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