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General NPI Number Information
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NPI Number | 1386874840
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Entity Type | Organization
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Legal Business Name | HERD COMMUNITY DEVELOPMENT CORPORATION
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Dates
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Enumeration Date | 07/19/2009
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Last Update Date | 07/19/2009
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Provider Practice Location Address
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Address Line | 6820 LA TIJERA BLVD STE. 217
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City | LOS ANGELES
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State | CA
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Zip | 90045-1908
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Country | US
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Telephone | 310-568-0244
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Fax | 310-568-8202
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Provider Business Mailing Address
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Address Line | PO BOX 881329
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City | LOS ANGELES
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State | CA
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Zip | 90009-7329
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Country | US
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Telephone | 310-641-0870
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Fax | 310-641-8476
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. KIMBERLY WILLIAMS-RYAN
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Credential |
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Telephone | 310-500-7249
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State |
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