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General NPI Number Information
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NPI Number | 1679896781
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Entity Type | Organization
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Legal Business Name | PLAZA COMMUNITY CENTER
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Dates
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Enumeration Date | 03/03/2010
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Last Update Date | 03/03/2010
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Provider Practice Location Address
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Address Line | 5255 POMONA BLVD STE 5
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City | LOS ANGELES
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State | CA
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Zip | 90022-1753
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Country | US
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Telephone | 323-888-2530
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Fax | 323-726-3510
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Provider Business Mailing Address
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Address Line | 4018 CITY TERRACE DR
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City | LOS ANGELES
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State | CA
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Zip | 90063-1242
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Country | US
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Telephone | 323-267-9749
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Fax | 323-267-0375
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DR. GABRIEL BUELNA
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Credential | PH.D.
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Telephone | 323-267-9749
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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 |
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License Number State | CA
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