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General NPI Number Information
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NPI Number | 1184110678
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Entity Type | Organization
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Legal Business Name | ALAVIDA USA
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Dates
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Enumeration Date | 07/08/2018
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Last Update Date | 07/08/2018
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Provider Practice Location Address
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Address Line | 2500 BROADWAY STE F125
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City | SANTA MONICA
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State | CA
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Zip | 90404-3080
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Country | US
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Telephone | 888-315-0587
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Fax |
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Provider Business Mailing Address
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Address Line | 2500 BROADWAY STE F125
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City | SANTA MONICA
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State | CA
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Zip | 90404-3080
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Country | US
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Telephone | 888-315-0587
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | ALEX LEE
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Credential | LCSW
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Telephone | 888-315-0887
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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