Healthcare Provider Details

I. General information

NPI: 1487999892
Provider Name (Legal Business Name): SERGIO BARRON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2012
Last Update Date: 12/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5250 SANTA MONICA BLVD 218/
LOS ANGELES CA
90029-1252
US

IV. Provider business mailing address

5250 SANTA MONICA BLVD 218
LOS ANGELES CA
90029-1252
US

V. Phone/Fax

Practice location:
  • Phone: 323-465-3777
  • Fax: 323-465-3773
Mailing address:
  • Phone: 323-465-3777
  • Fax: 323-465-3773

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: