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General NPI Number Information
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NPI Number | 1376304436
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Entity Type | Organization
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Legal Business Name | GENESIS LA TRANSPORTATION LLC
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Dates
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Enumeration Date | 01/17/2024
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Last Update Date | 05/28/2024
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Provider Practice Location Address
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Address Line | 26201 OZONE AVENUE
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City | HARBOR CITY
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State | CA
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Zip | 90710
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Country | US
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Telephone | 562-449-3878
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Fax |
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Provider Business Mailing Address
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Address Line | 8605 SANTA MONICA BLVD # 273305
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City | WEST HOLLYWOOD
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State | CA
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Zip | 90069-4109
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Country | US
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Telephone | 562-449-3878
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. MARY ANN ROQUE
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Credential |
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Telephone | 310-658-0436
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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