Healthcare Provider Details

I. General information

NPI: 1801142963
Provider Name (Legal Business Name): AEGIS MEDICAL SYSTEMS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2012
Last Update Date: 07/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7256 REMMET AVE
CANOGA PARK CA
91303
US

IV. Provider business mailing address

14240 IMPERIAL HWY
LA MIRADA CA
90638-1940
US

V. Phone/Fax

Practice location:
  • Phone: 818-206-0360
  • Fax: 818-206-0370
Mailing address:
  • Phone: 562-946-1587
  • Fax: 562-946-5740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number19-053
License Number StateCA

VIII. Authorized Official

Name: MS. CINDY JOO YOUNG LEE
Title or Position: COUNSELOR
Credential: M.A.
Phone: 562-946-1587