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General NPI Number Information
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NPI Number | 1144622689
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Entity Type | Organization
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Legal Business Name | EPIDAURUS
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Dates
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Enumeration Date | 09/16/2014
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Last Update Date | 12/29/2021
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Provider Practice Location Address
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Address Line | 3750 S GRAND AVE
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City | LOS ANGELES
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State | CA
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Zip | 90007-4331
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Country | US
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Telephone | 213-743-9078
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3043
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City | TUCSON
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State | AZ
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Zip | 85702-3043
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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 | CHIEF EXECUTIVE OFFICER
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Name | DOUG G BOND
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Credential |
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Telephone | 213-400-4243
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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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