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General NPI Number Information
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NPI Number | 1124442850
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Entity Type | Organization
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Legal Business Name | ASSISTANCE LEAGUE OF SAN PEDRO-SOUTH BAY
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Dates
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Enumeration Date | 02/18/2014
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Last Update Date | 12/03/2019
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Provider Practice Location Address
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Address Line | 1441 W 8TH ST
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City | SAN PEDRO
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State | CA
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Zip | 90732-3803
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Country | US
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Telephone | 310-832-8355
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Fax | 310-832-8460
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Provider Business Mailing Address
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Address Line | 1441 W 8TH ST
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City | SAN PEDRO
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State | CA
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Zip | 90732-3803
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Country | US
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Telephone | 310-832-8355
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Fax | 310-832-8460
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. SHARON JEAN COLE
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Credential |
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Telephone | 310-435-2624
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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