Healthcare Provider Details

I. General information

NPI: 1548448863
Provider Name (Legal Business Name): LOS ANGELES COUNTY DEPT. OF MENTAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2008
Last Update Date: 02/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17707 STUDEBAKER RD
CERRITOS CA
90703-2640
US

IV. Provider business mailing address

17707 STUDEBAKER RD
CERRITOS CA
90703-2640
US

V. Phone/Fax

Practice location:
  • Phone: 562-467-0209
  • Fax:
Mailing address:
  • Phone: 562-467-0209
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License NumberPT22255
License Number StateCA

VIII. Authorized Official

Name: MR. PAUL V. LOPEZ SR.
Title or Position: LICENSED PSYCHIATRIC TECHNICIAN
Credential:
Phone: 562-467-0209