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General NPI Number Information
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NPI Number | 1225534332
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Entity Type | Organization
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Legal Business Name | GOSPEL LIGHT BIBLE CHURCH
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Dates
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Enumeration Date | 04/05/2018
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Last Update Date | 04/05/2018
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Provider Practice Location Address
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Address Line | 1816 DESIRE AVE
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City | ROWLAND HEIGHTS
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State | CA
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Zip | 91748-2917
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Country | US
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Telephone | 626-927-7712
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Fax |
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Provider Business Mailing Address
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Address Line | 1816 DESIRE AVE
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City | ROWLAND HEIGHTS
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State | CA
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Zip | 91748-2917
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Country | US
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Telephone | 626-927-7712
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | NATALIE WEI
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Credential |
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Telephone | 626-927-7712
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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