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General NPI Number Information
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NPI Number | 1669727855
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Entity Type | Organization
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Legal Business Name | AVALON BY THE SEA, INC
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Dates
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Enumeration Date | 07/13/2012
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Last Update Date | 03/16/2016
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Provider Practice Location Address
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Address Line | 32420 PACIFIC COAST HWY
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City | MALIBU
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State | CA
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Zip | 90265-2531
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Country | US
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Telephone | 310-457-9111
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Fax |
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Provider Business Mailing Address
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Address Line | 30765 PACIFIC COAST HWY 376
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City | MALIBU
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State | CA
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Zip | 90265-3646
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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 | DIRECTOR OF BUSINESS DEVELOPMENT
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Name | VALENTIN GASPARYAN
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Credential |
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Telephone | 310-457-9111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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