Healthcare Provider Details

I. General information

NPI: 1811154149
Provider Name (Legal Business Name): DEPARTMENT OF MENTAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2008
Last Update Date: 05/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 E 120TH ST
LA CA
90059
US

IV. Provider business mailing address

1720 E 120TH ST
LA CA
90059
US

V. Phone/Fax

Practice location:
  • Phone: 310-668-3403
  • Fax: 310-223-0621
Mailing address:
  • Phone: 310-668-3403
  • Fax: 310-223-0621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. BRENDA TORRES
Title or Position: SENIOR COMMUNITY WORKER I
Credential: NONE
Phone: 310-668-3403