Healthcare Provider Details

I. General information

NPI: 1720924616
Provider Name (Legal Business Name): XIDUS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2026
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9514 1/4 CEDAR ST
BELLFLOWER CA
90706-6515
US

IV. Provider business mailing address

9514 1/4 CEDAR ST
BELLFLOWER CA
90706-6515
US

V. Phone/Fax

Practice location:
  • Phone: 909-938-5322
  • Fax:
Mailing address:
  • Phone: 909-938-5322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: LYSA LYNNETTE LIGGINS
Title or Position: OWNER /PRESIDENT
Credential: EDD, PHD
Phone: 909-938-5322