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General NPI Number Information
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NPI Number | 1457145690
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Entity Type | Organization
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Legal Business Name | AVALON LA
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Dates
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Enumeration Date | 04/04/2025
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Last Update Date | 04/04/2025
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Provider Practice Location Address
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Address Line | 6622 CRENSHAW BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90043-4102
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Country | US
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Telephone | 818-599-3736
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Fax |
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Provider Business Mailing Address
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Address Line | 435 ARDEN AVE STE 380
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City | GLENDALE
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State | CA
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Zip | 91203-1147
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Country | US
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Telephone | 818-599-3736
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | CELINE MORADI
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Credential |
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Telephone | 818-599-3736
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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