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General NPI Number Information
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NPI Number | 1275707366
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Entity Type | Organization
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Legal Business Name | LOS ANGELES COUNTY PROBATION
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Dates
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Enumeration Date | 04/18/2008
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Last Update Date | 04/18/2008
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Provider Practice Location Address
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Address Line | 10028 WISNER AVE
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City | MISSION HILLS
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State | CA
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Zip | 91345-3037
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Country | US
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Telephone | 818-891-4347
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Fax |
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Provider Business Mailing Address
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Address Line | 10028 WISNER AVE
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City | MISSION HILLS
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State | CA
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Zip | 91345-3037
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Country | US
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Telephone | 818-891-4347
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Fax |
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Authorized Official
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Title or Position | STAFF ASSISTANT
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Name | MR. DEJAUN BLEDSOE
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Credential | ADULT FIELD SERVICES
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Telephone | 562-940-3694
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number | 171M00000X
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License Number State | CA
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