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1225 W 190th St Suite 220 Gardena CA 90248-4320 | |
(310) 851-6020 | |
(310) 323-6888 |
Full Name | |
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Speciality | Psychologist |
Location | 1225 W 190th St, Gardena, California |
Authorized Official Name and Position | Cliff Sabath (PRESIDENT) |
Authorized Official Contact | 3108516020 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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1225 W 190th St Suite 200 Gardena CA 90248-4320 Ph: (310) 851-6020 | 1225 W 190th St Suite 220 Gardena CA 90248-4320 Ph: (310) 851-6020 |
NPI Number | 1295102630 |
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Provider Enumeration Date | 09/01/2015 |
Last Update Date | 01/21/2016 |
Medicare PECOS PAC ID | 3274834981 |
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Medicare Enrollment ID | O20151223000371 |
Identifier | Type | State | Issuer |
---|---|---|---|
1295102630 | NPI | - | NPPES |
1942310750 | Other | CA | INDIVIDUAL NPI |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
103T00000X | Psychologist | PSY6872 (California) | Primary |
Provider Name | Cliff Sabath |
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Provider Type | Practitioner - Clinical Psychologist |
Provider Identifiers | NPI Number: 1942310750 PECOS PAC ID: 4183925894 Enrollment ID: I20151223000415 |
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