Healthcare Provider Details

I. General information

NPI: 1225178924
Provider Name (Legal Business Name): SOUTH BAY CHILDREN'S HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 04/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1617 CRAVENS AVE
TORRANCE CA
90501-3203
US

IV. Provider business mailing address

1617 CRAVENS AVE
TORRANCE CA
90501-3203
US

V. Phone/Fax

Practice location:
  • Phone: 310-328-0855
  • Fax: 310-328-9636
Mailing address:
  • Phone: 310-328-0855
  • Fax: 310-328-9636

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number960000038
License Number StateCA

VIII. Authorized Official

Name: MS. CHRISTINA J. HARRIS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 310-316-1212