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General NPI Number Information
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NPI Number | 1194859587
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Entity Type | Organization
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Legal Business Name | WATTS LABOR COMMUNITY ACTION COMMITTEE
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Dates
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Enumeration Date | 03/15/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 12206 S WILMINGTON AVE
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City | COMPTON
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State | CA
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Zip | 90222-1283
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Country | US
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Telephone | 310-763-6752
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Fax |
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Provider Business Mailing Address
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Address Line | 10950 S CENTRAL AVE
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City | LOS ANGELES
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State | CA
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Zip | 90059-1024
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Country | US
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Telephone | 323-563-5639
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Fax |
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Authorized Official
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Title or Position | GENERAL MANAGER
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Name | PARKER ANDERSON
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Credential |
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Telephone | 323-249-1548
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225400000X
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Taxonomy Name | Rehabilitation Practitioner
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License Number |
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License Number State |
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