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General NPI Number Information
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NPI Number | 1740606201
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Entity Type | Organization
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Legal Business Name | ORGANIZATION REACHOUT, INC.
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Dates
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Enumeration Date | 03/07/2014
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Last Update Date | 03/07/2014
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Provider Practice Location Address
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Address Line | 920 N LONG BEACH BLVD SUITE 1
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City | COMPTON
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State | CA
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Zip | 90221-2260
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Country | US
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Telephone | 310-669-9400
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Fax | 310-669-9403
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Provider Business Mailing Address
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Address Line | 920 N LONG BEACH BLVD SUITE 1
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City | COMPTON
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State | CA
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Zip | 90221-2260
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Country | US
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Telephone | 310-669-9400
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Fax | 310-669-9403
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Authorized Official
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Title or Position | OPERATIONS MANAGER
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Name | SHELIA DIANE ABBY
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Credential |
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Telephone | 310-462-8840
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 10891
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License Number State | CA
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