Healthcare Provider Details

I. General information

NPI: 1528229879
Provider Name (Legal Business Name): REBUILD CALIFORNIA ALLIANCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2008
Last Update Date: 04/08/2026
Certification Date: 04/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 W 99TH ST
LOS ANGELES CA
90003-4114
US

IV. Provider business mailing address

7622 AVALON BLVD
LOS ANGELES CA
90003-2326
US

V. Phone/Fax

Practice location:
  • Phone: 323-422-1124
  • Fax: 323-531-4063
Mailing address:
  • Phone: 323-422-1124
  • Fax: 323-920-7380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DEANTWAN MARQUIS FITTS
Title or Position: FOUNDER
Credential:
Phone: 323-422-1124