Healthcare Provider Details

I. General information

NPI: 1134206592
Provider Name (Legal Business Name): COMPTON MENTAL HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2460 PINE AVE
LONG BEACH CA
90806-3030
US

IV. Provider business mailing address

2460 PINE AVE
LONG BEACH CA
90806-3030
US

V. Phone/Fax

Practice location:
  • Phone: 310-668-6800
  • Fax:
Mailing address:
  • Phone: 310-668-6800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA35468
License Number StateCA

VIII. Authorized Official

Name: DOLORES HERNANDEZ
Title or Position: MH PSYCHIATRIST
Credential:
Phone: 310-668-6865