| Step Up On Second Street | |
|
1328 2nd St Santa Monica CA 90401-1122 | |
| (310) 394-6889 | |
| (310) 394-6883 |
| Full Name | Step Up On Second Street |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 1328 2nd St, Santa Monica, California |
| Authorized Official Name and Position | Tod Lipka (CEO) |
| Authorized Official Contact | 3103946889 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Step Up On Second Street 1328 2nd St Santa Monica CA 90401-1122 Ph: (310) 394-6889 | Step Up On Second Street 1328 2nd St Santa Monica CA 90401-1122 Ph: (310) 394-6889 |
| NPI Number | 1831228626 |
|---|---|
| Provider Enumeration Date | 03/05/2007 |
| Last Update Date | 10/31/2012 |
| Medicare PECOS PAC ID | 2264568112 |
|---|---|
| Medicare Enrollment ID | O20110715000349 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831228626 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Liliane Lebas |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1922178334 PECOS PAC ID: 6103894308 Enrollment ID: I20040923001216 |
| Provider Name | Lawrence O Ogbechie |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1003868217 PECOS PAC ID: 0244326528 Enrollment ID: I20071017000968 |
| Provider Name | Igor V Hunkoff |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1629273396 PECOS PAC ID: 8426145624 Enrollment ID: I20110228000283 |
| Provider Name | Duc Trong Nguyen |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1639353766 PECOS PAC ID: 1850574864 Enrollment ID: I20110329000952 |
| Provider Name | Dana L Harris |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1164614525 PECOS PAC ID: 6800074824 Enrollment ID: I20110622000349 |
| Provider Name | Emily M Sutton-james |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1093836892 PECOS PAC ID: 2567629595 Enrollment ID: I20120202000831 |
| Provider Name | Eleanore M Baidoo |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1255459939 PECOS PAC ID: 4486811387 Enrollment ID: I20120203000697 |
| Provider Name | John A Jimenez |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1518286137 PECOS PAC ID: 7214188721 Enrollment ID: I20121109000391 |
| Provider Name | Amanda Jeanna Fata |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1164755427 PECOS PAC ID: 3971829219 Enrollment ID: I20150305000003 |
| Provider Name | Timothy Jack |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1891949723 PECOS PAC ID: 1658691027 Enrollment ID: I20150527000002 |
| Provider Name | Sanaz Parsa |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1295923902 PECOS PAC ID: 2769536382 Enrollment ID: I20170215001655 |
| Provider Name | Taiye Owareye Osawe |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1396116703 PECOS PAC ID: 1254679921 Enrollment ID: I20190205003531 |
| Provider Name | Jamie Lee Plaxco |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295257269 PECOS PAC ID: 7214268465 Enrollment ID: I20191018002290 |
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