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General NPI Number Information
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NPI Number | 1164767141
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Entity Type | Organization
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Legal Business Name | SOUTHERN CALIFORNIA INDIAN CENTER
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Dates
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Enumeration Date | 12/03/2012
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Last Update Date | 12/03/2012
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Provider Practice Location Address
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Address Line | 5805 N FIGUEROA ST
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City | HIGHLAND PARK
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State | CA
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Zip | 90042-4227
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Country | US
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Telephone | 323-274-1070
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Fax |
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Provider Business Mailing Address
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Address Line | 10175 SLATER AVE STE 150
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City | FOUNTAIN VALLEY
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State | CA
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Zip | 92708-4717
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Country | US
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Telephone | 714-962-6673
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Fax |
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Authorized Official
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Title or Position | EXCECUTIVE DIRECTOR
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Name | PAULA STARR
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Credential |
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Telephone | 714-662-6673
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State |
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Taxonomy #2
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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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