Healthcare Provider Details

I. General information

NPI: 1003139668
Provider Name (Legal Business Name): DEPAREMENT OF MANTAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2010
Last Update Date: 03/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 W CARSON ST
TORRANCE CA
90502-2004
US

IV. Provider business mailing address

1000 W CARSON ST
TORRANCE CA
90502-2004
US

V. Phone/Fax

Practice location:
  • Phone: 310-222-1648
  • Fax: 310-222-5651
Mailing address:
  • Phone: 310-222-1648
  • Fax: 310-222-5651

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number362151
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License Number362151
License Number StateCA

VIII. Authorized Official

Name: MS. VICKIE BURRIS
Title or Position: REGISTERED NURSE
Credential: LICENSE
Phone: 310-222-1648