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NPI Code Detail

MEDICARE: GLADYS ITCHON I

MEDICARE: GLADYS ITCHON I
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
1101YA0400XAddiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number : 1760926497
Entity Type Code : Individual
Provider Name (Legal Business Name) : GLADYS ITCHON I
Provider Business Mailing Address
First Line : 909 PICO BLVD
Second Line :
City : SANTA MONICA
State : CA
Zip : 90405-1326
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 844 PICO BLVD
Second Line :
City : SANTA MONICA
State : CA
Zip : 90405-1325
Country : US
Telephone Number : 310-314-6200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/14/2016
Last Update Date : 12/14/2016

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Directions to “ GLADYS ITCHON I ” Practice Location

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