Healthcare Provider Details

I. General information

NPI: 1053226639
Provider Name (Legal Business Name): ALAN MAURICIO COLLINS RADT-1
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2521 LONG BEACH AVE
LOS ANGELES CA
90058-1324
US

IV. Provider business mailing address

1203 W 85TH ST
LOS ANGELES CA
90044-2217
US

V. Phone/Fax

Practice location:
  • Phone: 213-389-1500
  • Fax: 213-383-2493
Mailing address:
  • Phone: 323-219-0698
  • 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: