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General NPI Number Information
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NPI Number | 1568652915
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Entity Type | Organization
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Legal Business Name | CITY OF GARDENA
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Dates
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Enumeration Date | 07/31/2007
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Last Update Date | 12/11/2020
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Provider Practice Location Address
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Address Line | 2320 W 149TH ST
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City | GARDENA
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State | CA
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Zip | 90249-3702
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Country | US
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Telephone | 310-217-9537
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Fax | 310-217-6117
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Provider Business Mailing Address
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Address Line | 1670 W 162ND ST
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City | GARDENA
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State | CA
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Zip | 90247-3734
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Country | US
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Telephone | 310-217-9552
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Fax |
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Authorized Official
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Title or Position | RECREATION THERAPIST
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Name | MR. LAYNE S. WAKUTA
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Credential |
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Telephone | 310-217-9552
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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