Healthcare Provider Details

I. General information

NPI: 1891884128
Provider Name (Legal Business Name): LOS ANGELES DEPARTMENT OF MENTAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17707 STUDEBAKER RD
CERRITOS CA
90703-2640
US

IV. Provider business mailing address

1307 VOLTAIRE DR
RIVERSIDE CA
92506-5385
US

V. Phone/Fax

Practice location:
  • Phone: 156-246-7020
  • Fax: 156-240-2303
Mailing address:
  • Phone: 195-150-5850
  • Fax: 156-240-2303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberPT11926
License Number StateCA

VIII. Authorized Official

Name: MR. DAVID LYNN LESLIE I
Title or Position: LICENSED PSYCHIATRIC TECHNICIAN
Credential: LICENSED PSYCH TECH
Phone: 562-467-0209