Healthcare Provider Details

I. General information

NPI: 1992243380
Provider Name (Legal Business Name): VISTA DEL MAR CHILD AND FAMILY SVC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2017
Last Update Date: 03/01/2022
Certification Date: 03/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3321 EDITH ST
LOS ANGELES CA
90064-4736
US

IV. Provider business mailing address

3200 MOTOR AVE
LOS ANGELES CA
90034-3710
US

V. Phone/Fax

Practice location:
  • Phone: 310-836-1223
  • Fax: 310-204-1405
Mailing address:
  • Phone: 310-836-1223
  • Fax: 310-204-1405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: CHERYL CARRINGTON
Title or Position: DIRECTOR QUALITY, STANDARDS AND COM
Credential:
Phone: 310-836-1223