Healthcare Provider Details

I. General information

NPI: 1235854886
Provider Name (Legal Business Name): IGNTD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2022
Last Update Date: 04/19/2024
Certification Date: 04/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4144 KENWAY AVE
VIEW PARK CA
90008-4810
US

IV. Provider business mailing address

4144 KENWAY AVE
VIEW PARK CA
90008-4810
US

V. Phone/Fax

Practice location:
  • Phone: 310-488-3978
  • Fax:
Mailing address:
  • Phone: 888-557-7217
  • Fax: 888-739-6925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name: ADI JAFFE
Title or Position: CEO/EXECUTIVE DIRECTOR
Credential: PHD, ADC
Phone: 310-488-3978