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General NPI Number Information
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NPI Number | 1376761361
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Entity Type | Organization
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Legal Business Name | CALIFORNIA DRUG TREATMENT PROGRAM, INC.
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Dates
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Enumeration Date | 04/23/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 915 W WASHINGTON BLVD SUITE B
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City | LOS ANGELES
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State | CA
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Zip | 90015-3311
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Country | US
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Telephone | 213-747-0054
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Fax | 213-747-9515
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Provider Business Mailing Address
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Address Line | 915 W WASHINGTON BLVD SUITE B
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City | LOS ANGELES
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State | CA
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Zip | 90015-3311
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Country | US
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Telephone | 213-747-0054
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Fax | 213-747-9515
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Authorized Official
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Title or Position | CEO
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Name | OSAYANDE AGHAZEBAMWAN
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Credential |
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Telephone | 213-747-0054
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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