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General NPI Number Information
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NPI Number | 1699005140
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Entity Type | Organization
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Legal Business Name | ESPERANZA DRUG AND ALCOHOL PROGRAM
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Dates
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Enumeration Date | 01/06/2010
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Last Update Date | 01/06/2010
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Provider Practice Location Address
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Address Line | 5255 POMONA BLVD STE 2AND5
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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 | 5255 POMONA BLVD STE 2AND5
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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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Authorized Official
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Title or Position | SUPERVISOR
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Name | CHARITO CARILLO
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Credential |
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Telephone | 323-888-2530
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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 |
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License Number State |
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