Healthcare Provider Details

I. General information

NPI: 1003533001
Provider Name (Legal Business Name): DIDI HIRSCH PSYCHIATRIC SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2022
Last Update Date: 11/23/2022
Certification Date: 11/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11044 S FREEMAN AVE
INGLEWOOD CA
90304-2418
US

IV. Provider business mailing address

4760 SEPULVEDA BLVD
CULVER CITY CA
90230-4820
US

V. Phone/Fax

Practice location:
  • Phone: 310-677-7808
  • Fax: 310-751-5481
Mailing address:
  • Phone: 310-390-6612
  • Fax: 310-751-5481

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: DULCE M RUIZ
Title or Position: CONTRACTS & GRANTS MANAGER
Credential:
Phone: 310-751-5442