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General NPI Number Information
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NPI Number | 1588008361
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Entity Type | Organization
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Legal Business Name | MEDI-CURE HEALTH SERVICES
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Dates
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Enumeration Date | 04/23/2013
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Last Update Date | 04/23/2013
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Provider Practice Location Address
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Address Line | 1921 WEST ARROYO STREET
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City | POMONA
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State | CA
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Zip | 91768
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Country | US
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Telephone | 323-295-1136
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Fax | 323-295-1071
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Provider Business Mailing Address
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Address Line | 3756 SANTA ROSALIA DR 417
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City | LOS ANGELES
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State | CA
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Zip | 90008-3606
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Country | US
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Telephone | 323-295-1136
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Fax | 323-295-1071
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR/CEO
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Name | DR. JOSEPHINE C KANNIKE-MARTINS
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Credential | PHD., RD
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Telephone | 323-295-1136
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 190636AN
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License Number State | CA
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