Healthcare Provider Details

I. General information

NPI: 1003759481
Provider Name (Legal Business Name): BREAKING STIGMAS TREATMENT OPERATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2026
Last Update Date: 04/10/2026
Certification Date: 04/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

685 W 18TH ST
SAN PEDRO CA
90731-5418
US

IV. Provider business mailing address

685 W 18TH ST
SAN PEDRO CA
90731-5418
US

V. Phone/Fax

Practice location:
  • Phone: 310-365-5761
  • Fax:
Mailing address:
  • Phone: 310-365-5761
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: TERI RUSHAWN ROGERS
Title or Position: FOUNDER/CEO
Credential: PEER SPECIALIST
Phone: 310-365-5761