Healthcare Provider Details

I. General information

NPI: 1689443772
Provider Name (Legal Business Name): EPIDAURUS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2023
Last Update Date: 07/09/2025
Certification Date: 07/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3316 S MAIN ST
LOS ANGELES CA
90007-4126
US

IV. Provider business mailing address

PO BOX 3043
TUCSON AZ
85702-3043
US

V. Phone/Fax

Practice location:
  • Phone: 323-387-9146
  • Fax:
Mailing address:
  • Phone: 520-910-0401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: OLGA MELLIZO
Title or Position: CHIEF DEVELOPMENT OFFICER
Credential:
Phone: 970-889-2351