Healthcare Provider Details

I. General information

NPI: 1679811079
Provider Name (Legal Business Name): VIP DRUG AND ALCOHOL EDUCATION CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2013
Last Update Date: 04/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17000 HAYNES ST D-13
LAKE BALBOA CA
91406-5420
US

IV. Provider business mailing address

18417 NORDHOFF ST STE D
NORTHRIDGE CA
91325-2276
US

V. Phone/Fax

Practice location:
  • Phone: 818-734-2761
  • Fax: 818-734-2762
Mailing address:
  • Phone: 818-734-2761
  • Fax: 818-734-2762

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: MRS. ARMINE TOROSYAN
Title or Position: SECRETARY
Credential:
Phone: 818-734-2761