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General NPI Number Information
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NPI Number | 1366790537
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Entity Type | Organization
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Legal Business Name | SPONDERWORKS CHILDRENS SERVICES
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Dates
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Enumeration Date | 08/20/2012
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Last Update Date | 08/20/2012
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Provider Practice Location Address
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Address Line | 1520 S WESTERN AVE
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City | SAN PEDRO
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State | CA
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Zip | 90732-3602
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Country | US
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Telephone | 310-521-0112
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Fax | 310-831-7291
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Provider Business Mailing Address
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Address Line | 1536 W 25TH ST STE 172
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City | SAN PEDRO
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State | CA
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Zip | 90732-4415
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Country | US
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Telephone | 310-521-0112
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Fax | 310-831-7291
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Authorized Official
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Title or Position | C.E.O.
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Name | MR. DAVID SPNDER
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Credential | B.C.B.A; L.E.P.
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Telephone | 310-521-0112
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 2348
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License Number State | CA
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