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General NPI Number Information
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NPI Number | 1154920684
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Entity Type | Organization
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Legal Business Name | ST JOHN BOSCO HIGH SCHOOL
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Dates
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Enumeration Date | 10/26/2020
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Last Update Date | 10/26/2020
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Provider Practice Location Address
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Address Line | 13640 BELLFLOWER BLVD
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City | BELLFLOWER
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State | CA
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Zip | 90706-2408
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Country | US
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Telephone | 562-920-1734
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Fax |
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Provider Business Mailing Address
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Address Line | 5050 SPRING VALLEY RD
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City | DALLAS
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State | TX
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Zip | 75244-3995
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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 | ADMISTRATOR
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Name | MELODY MOHEBBI
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Credential |
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Telephone | 562-920-1734
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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