Healthcare Provider Details

I. General information

NPI: 1306661749
Provider Name (Legal Business Name): ALFRED REMIJIO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2024
Last Update Date: 06/10/2025
Certification Date: 06/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3619 N MISSION RD
LINCOLN HEIGHTS CA
90031-3136
US

IV. Provider business mailing address

11027 BURBANK BLVD
NORTH HOLLYWOOD CA
91601-2431
US

V. Phone/Fax

Practice location:
  • Phone: 213-721-0100
  • Fax:
Mailing address:
  • Phone: 818-985-8323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: