| Ssg/ottp | |
|
879 W 190th St Suites 320 350 360 380 390 Gardena CA 90248-4223 | |
| (310) 323-6887 | |
| (310) 323-1570 |
| Full Name | Ssg/ottp |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 879 W 190th St, Gardena, California |
| Authorized Official Name and Position | Herbert K Hatanaka (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 2135531800 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ssg/ottp 905 E 8th St Los Angeles CA 90021-1848 Ph: (213) 553-1800 | Ssg/ottp 879 W 190th St Suites 320 350 360 380 390 Gardena CA 90248-4223 Ph: (310) 323-6887 |
| NPI Number | 1669503629 |
|---|---|
| Provider Enumeration Date | 03/08/2007 |
| Last Update Date | 10/02/2024 |
| Certification Date | 10/02/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669503629 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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