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General NPI Number Information
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NPI Number | 1053617241
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Entity Type | Organization
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Legal Business Name | SUBSTANCE ABUSE SPECIALIST INC.
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Dates
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Enumeration Date | 02/04/2011
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Last Update Date | 02/04/2011
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Provider Practice Location Address
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Address Line | 14515 HAMLIN ST
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City | VAN NUYS
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State | CA
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Zip | 91411-1608
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Country | US
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Telephone | 323-387-2405
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Fax | 323-727-0284
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Provider Business Mailing Address
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Address Line | 14515 HAMLIN ST
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City | VAN NUYS
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State | CA
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Zip | 91411-1608
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Country | US
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Telephone | 323-387-2405
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Fax | 323-727-0284
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Authorized Official
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Title or Position | CEO
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Name | OSCAR DE LA O
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Credential |
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Telephone | 213-280-3805
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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