Healthcare Provider Details

I. General information

NPI: 1740712926
Provider Name (Legal Business Name): SITUMBA YUMANDA STANSBERRY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2017
Last Update Date: 12/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

351 E 6TH ST
LONG BEACH CA
90802-1402
US

IV. Provider business mailing address

4771 S MAIN ST
LOS ANGELES CA
90037-3250
US

V. Phone/Fax

Practice location:
  • Phone: 562-435-7350
  • Fax: 562-432-4532
Mailing address:
  • Phone: 323-233-3342
  • Fax: 323-233-3183

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: