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1225 W 190th St Ste 255 Gardena CA 90248-4342 | |
| (310) 217-0930 | |
| (310) 217-0907 |
| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 1225 W 190th St Ste 255, Gardena, California |
| Authorized Official Name and Position | Tiffany Danielle Sickler (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 9166525802 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 1403 Loomis CA 95650-1403 Ph: (916) 652-5802 | 1225 W 190th St Ste 255 Gardena CA 90248-4342 Ph: (310) 217-0930 |
| NPI Number | 1467997403 |
|---|---|
| Provider Enumeration Date | 12/29/2016 |
| Last Update Date | 02/23/2023 |
| Certification Date | 02/23/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467997403 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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