Healthcare Provider Details

I. General information

NPI: 1497196711
Provider Name (Legal Business Name): SOUTHERN CALIFORNIA INDIAN CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2013
Last Update Date: 07/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5809 N FIGUEROA ST
HIGHLAND PARK CA
90042-4227
US

IV. Provider business mailing address

5809 N FIGUEROA ST
HIGHLAND PARK CA
90042-4227
US

V. Phone/Fax

Practice location:
  • Phone: 323-274-1070
  • Fax:
Mailing address:
  • Phone: 323-274-1070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: PAULA STARR
Title or Position: DIRECTOR
Credential:
Phone: 714-962-6673