Healthcare Provider Details

I. General information

NPI: 1124943709
Provider Name (Legal Business Name): THE OUTREACH INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 WASHINGTON BLVD SUITE 19
MARINA DEL REU CA
90292
US

IV. Provider business mailing address

475 WASHINGTON BLVD SUITE 19
MARINA DEL REU CA
90292
US

V. Phone/Fax

Practice location:
  • Phone: 562-659-0950
  • Fax: 310-974-4296
Mailing address:
  • Phone: 562-659-0950
  • Fax: 310-974-4296

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. DEIONNA L GIPSON
Title or Position: PROGRAM DIRECTOR
Credential:
Phone: 562-659-0950