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General NPI Number Information
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NPI Number | 1508653304
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Entity Type | Organization
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Legal Business Name | UNITED STATES VETERANS INITIATIVE - COLTON
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Dates
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Enumeration Date | 04/23/2025
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Last Update Date | 07/07/2025
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Provider Practice Location Address
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Address Line | 937 VIA LATA STE 100
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City | COLTON
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State | CA
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Zip | 92324-3958
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Country | US
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Telephone | 213-542-2622
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Fax |
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Provider Business Mailing Address
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Address Line | 800 W 6TH ST STE 1505
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City | LOS ANGELES
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State | CA
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Zip | 90017-2742
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Country | US
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Telephone | 213-760-4630
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Fax |
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Authorized Official
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Title or Position | MED BILLING PROJECT COORDINATOR
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Name | LISA R JACKSON ZENO
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Credential |
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Telephone | 213-542-2622
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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