Healthcare Provider Details

I. General information

NPI: 1881904050
Provider Name (Legal Business Name): OTHERS INTERNATIONAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2010
Last Update Date: 10/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 S MAIN ST 226
POMONA CA
91766-1624
US

IV. Provider business mailing address

101 W MISSION BLVD 110-141
POMONA CA
91766-1711
US

V. Phone/Fax

Practice location:
  • Phone: 909-649-7261
  • Fax:
Mailing address:
  • Phone: 909-649-7261
  • Fax: 909-796-2537

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS26590
License Number StateCA

VIII. Authorized Official

Name: MRS. SHIRLEY HUNT WIGGINS
Title or Position: PROGRAM COORDINATOR
Credential:
Phone: 909-649-7261