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1045 W Redondo Beach Blvd Fl 3 Gardena CA 90247-4128 | |
| (323) 241-6730 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 1045 W Redondo Beach Blvd Fl 3, Gardena, California |
| Authorized Official Name and Position | Lisa H. Wong (ACTING DIRECTOR) |
| Authorized Official Contact | 2137384601 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
510 S Vermont Ave Los Angeles CA 90020-1992 Ph: (213) 738-4601 | 1045 W Redondo Beach Blvd Fl 3 Gardena CA 90247-4128 Ph: (323) 241-6730 |
| NPI Number | 1861425282 |
|---|---|
| Provider Enumeration Date | 07/09/2006 |
| Last Update Date | 12/14/2022 |
| Certification Date | 12/14/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861425282 | NPI | - | NPPES |
| 1935 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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