Healthcare Provider Details

I. General information

NPI: 1538718531
Provider Name (Legal Business Name): HARBOR-UCLA DMH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2019
Last Update Date: 09/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HARBOR-UCLA DMH 1000 W CARSON ST BOX #498
TORRANCE CA
90502
US

IV. Provider business mailing address

HARBOR-UCLA DMH 1000 W CARSON ST BOX #498
TORRANCE CA
90502
US

V. Phone/Fax

Practice location:
  • Phone: 424-306-5737
  • Fax:
Mailing address:
  • Phone: 424-306-5737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name: LAUREN WAKABAYASHI
Title or Position: INTERN
Credential:
Phone: 808-295-6408