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555 W Redondo Beach Blvd # 215 Gardena CA 90248-1612 | |
| (310) 352-6422 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 555 W Redondo Beach Blvd # 215, Gardena, California |
| Authorized Official Name and Position | Cynthia Marshall (DIRECTOR OF PROGRAM ADMINISTRATION) |
| Authorized Official Contact | 3106455227 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
8929 S Sepulveda Blvd Ste 201 Los Angeles CA 90045-3643 Ph: (310) 645-5227 | 555 W Redondo Beach Blvd # 215 Gardena CA 90248-1612 Ph: (310) 352-6422 |
| NPI Number | 1053057216 |
|---|---|
| Provider Enumeration Date | 05/10/2022 |
| Last Update Date | 06/17/2022 |
| Certification Date | 06/17/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053057216 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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