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General NPI Number Information
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NPI Number | 1013242700
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Entity Type | Organization
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Legal Business Name | LOC DO
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Dates
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Enumeration Date | 10/13/2009
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Last Update Date | 10/26/2009
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Provider Practice Location Address
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Address Line | 13950 MILTON AVE SUITE 303
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City | WESTMINSTER
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State | CA
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Zip | 92683-2900
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Country | US
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Telephone | 714-901-4629
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Fax |
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Provider Business Mailing Address
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Address Line | 2632 E DENISE AVE
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City | ORANGE
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State | CA
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Zip | 92867-1816
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PROGRAM DIRECTOR
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Name | KATIE WELLS
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Credential |
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Telephone | 714-901-4629
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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