=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124437983
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UNITED AMERICAN INDIAN INVOLVEMENT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/06/2014
-----------------------------------------------------
Last Update Date | 05/23/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1453 W TEMPLE ST
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90026-5648
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 213-202-3970
-----------------------------------------------------
Fax | 213-975-9255
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1453 W TEMPLE ST
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90026-5648
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 213-202-3970
-----------------------------------------------------
Fax | 213-975-9255
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATIVE CLINICAL DIRECTOR
-----------------------------------------------------
Name | AL GARCIA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 213-202-3970
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR0405X
-----------------------------------------------------
Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
-----------------------------------------------------
License Number | 190364AN
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------