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General NPI Number Information
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NPI Number | 1669283867
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Entity Type | Organization
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Legal Business Name | NEW LIFE BEHAVIOR HEALTH SERVICES INC
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Dates
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Enumeration Date | 01/16/2025
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Last Update Date | 01/16/2025
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Provider Practice Location Address
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Address Line | 5024 TORRANCE BLVD
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City | TORRANCE
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State | CA
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Zip | 90503-4116
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Country | US
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Telephone | 310-490-7956
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Fax |
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Provider Business Mailing Address
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Address Line | 5024 TORRANCE BLVD
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City | TORRANCE
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State | CA
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Zip | 90503-4116
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. ABRAHAM AGIBA
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Credential | PMHNP
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Telephone | 310-490-7956
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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