| South Bay Mhs -- Fsp Program | |
|
1045 W Redondo Beach Blvd Fl 3 Gardena CA 90247-4128 | |
| (310) 970-5000 | |
| (323) 756-1163 |
| Full Name | South Bay Mhs -- Fsp Program |
|---|---|
| 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 |
|---|---|
| South Bay Mhs -- Fsp Program 510 S Vermont Ave Los Angeles CA 90020-1992 Ph: (213) 738-4601 | South Bay Mhs -- Fsp Program 1045 W Redondo Beach Blvd Fl 3 Gardena CA 90247-4128 Ph: (310) 970-5000 |
| NPI Number | 1760698112 |
|---|---|
| Provider Enumeration Date | 05/15/2007 |
| Last Update Date | 11/28/2022 |
| Certification Date | 11/28/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760698112 | NPI | - | NPPES |
| 7672 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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