Healthcare Provider Details

I. General information

NPI: 1417227554
Provider Name (Legal Business Name): NEW AGE ENTERPRISES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2012
Last Update Date: 11/16/2020
Certification Date: 08/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7320 FIRESTONE BLVD STE 105
DOWNEY CA
90241-4159
US

IV. Provider business mailing address

817 W BEVERLY BLVD STE 201
MONTEBELLO CA
90640-4265
US

V. Phone/Fax

Practice location:
  • Phone: 562-927-5820
  • Fax: 562-684-0102
Mailing address:
  • Phone: 562-927-5820
  • Fax: 562-684-0102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberOT 4566
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT 4566
License Number StateCA

VIII. Authorized Official

Name: MS. VALERIE M MENDOZA
Title or Position: REGIONAL MANAGER/HR
Credential: REGIONAL MANAGER/HR
Phone: 562-927-5820