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General NPI Number Information
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NPI Number | 1114335742
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Entity Type | Organization
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Legal Business Name | DMH
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Dates
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Enumeration Date | 07/28/2014
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Last Update Date | 07/28/2014
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Provider Practice Location Address
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Address Line | 16213 FELLOWSHIP ST
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City | LA PUENTE
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State | CA
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Zip | 91744-1327
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Country | US
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Telephone | 626-643-1305
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Fax |
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Provider Business Mailing Address
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Address Line | 16213 FELLOWSHIP
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City | LA PUENTE
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State | CA
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Zip | 91744
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Country | US
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Telephone | 626-643-1305
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Fax |
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Authorized Official
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Title or Position | PSYCHIATRIC TECHNICIAN
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Name | BRENDA MINNETTE CLARKSON
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Credential |
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Telephone | 626-643-1305
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 283Q00000X
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Taxonomy Name | Psychiatric Hospital
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License Number | PT35293
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License Number State | CA
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