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General NPI Number Information
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NPI Number | 1578990644
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Entity Type | Organization
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Legal Business Name | HIS GIFTS INC
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Dates
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Enumeration Date | 10/03/2013
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Last Update Date | 10/03/2013
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Provider Practice Location Address
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Address Line | 12204 SOUTH SAN PEDRO STREET LOS ANGELES, CA 90061 10910 LONG BEACH BLVD SUITE 103
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City | LYNWOOD
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State | CA
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Zip | 90262
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Country | US
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Telephone | 310-420-3512
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Fax |
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Provider Business Mailing Address
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Address Line | 12204 SOUTH SAN PEDRO STREET LOS ANGELES, CA 90061 10910 LONG BEACH BLVD STE 103
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City | LYNWOOD
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State | CA
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Zip | 90262
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Country | US
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Telephone | 310-420-3512
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MRS. DONNA MARTREICE FERGUSON
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Credential |
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Telephone | 310-420-3512
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | LCS14553
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License Number State | CA
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