MEDICARE: D'VEAL FAMILY AND YOUTH SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1083262513
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	D'VEAL FAMILY AND YOUTH SERVICES

Provider Business Mailing Address
First Line	:	2750 E WASHINGTON BLVD STE 230
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91107-1449
Country	:	US
Telephone Number	:	626-296-8900
Fax Number	:

Provider Business Practice Location Address
First Line	:	1600 E FOOTHILL BLVD
Second Line	:
City	:	GLENDORA
State	:	CA
Zip	:	91741-3024
Country	:	US
Telephone Number	:	626-963-5731
Fax Number	:

Authorized Official
Title or Position	:	DIR MIS SERVICES
Name	:	KIM BLACKMON
Credential	:
Telephone Number	:	626-296-8900

Provider Enumeration Date	:	08/28/2019
Last Update Date	:	07/28/2022

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Directions to “D'VEAL FAMILY AND YOUTH SERVICES ” Practice Location

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