Healthcare Provider Details

I. General information

NPI: 1316115447
Provider Name (Legal Business Name): ABRAHAM LINCOLN HIGH SCHOOL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2008
Last Update Date: 02/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5723 E. WHITTIER BLVD.
LOS ANGELES CA
90022
US

IV. Provider business mailing address

3501 N BROADWAY
LOS ANGELES CA
90031-2856
US

V. Phone/Fax

Practice location:
  • Phone: 323-278-0100
  • Fax: 323-728-9218
Mailing address:
  • Phone: 323-728-0100
  • Fax: 323-728-9218

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: MS. JACQUELINE CUELLAR BRAVO
Title or Position: PROGRAM DIRECTOR
Credential: B.A
Phone: 323-728-0100