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General NPI Number Information
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NPI Number | 1174432389
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Entity Type | Organization
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Legal Business Name | IDOM INDUSTRIES
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Dates
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Enumeration Date | 09/03/2026
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Last Update Date | 09/03/2026
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Provider Practice Location Address
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Address Line | 1605 W OLYMPIC BLVD STE 1047
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City | LOS ANGELES
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State | CA
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Zip | 90015-3876
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Country | US
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Telephone | 310-686-8828
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Fax |
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Provider Business Mailing Address
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Address Line | 14026 STARFLOWER CT
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City | EASTVALE
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State | CA
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Zip | 92880-9076
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Country | US
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Telephone | 310-671-0023
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Fax |
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Authorized Official
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Title or Position | ASW
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Name | DAWN BUNKLEY
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Credential |
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Telephone | 213-545-7154
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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