Healthcare Provider Details

I. General information

NPI: 1508189341
Provider Name (Legal Business Name): VIP COMMUNITY MENTAL HEALTH CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2010
Last Update Date: 03/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4024 DURFEE AVE
EL MONTE CA
91732-2510
US

IV. Provider business mailing address

1721 GRIFFIN AVE
LOS ANGELES CA
90031-3312
US

V. Phone/Fax

Practice location:
  • Phone: 626-450-8930
  • Fax:
Mailing address:
  • Phone: 323-221-4134
  • Fax: 323-221-4231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. ASTRID HEPPENSTALL-HEGER
Title or Position: CEO
Credential: M.D.
Phone: 323-221-4134