Healthcare Provider Details

I. General information

NPI: 1699005140
Provider Name (Legal Business Name): ESPERANZA DRUG AND ALCOHOL PROGRAM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2010
Last Update Date: 01/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5255 POMONA BLVD STE 2AND5
LOS ANGELES CA
90022-1753
US

IV. Provider business mailing address

5255 POMONA BLVD STE 2AND5
LOS ANGELES CA
90022-1753
US

V. Phone/Fax

Practice location:
  • Phone: 323-888-2530
  • Fax: 323-726-3510
Mailing address:
  • Phone: 323-888-2530
  • Fax: 323-726-3510

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: CHARITO CARILLO
Title or Position: SUPERVISOR
Credential:
Phone: 323-888-2530