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General NPI Number Information
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NPI Number | 1760882336
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Entity Type | Organization
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Legal Business Name | SOLE PROPRIETOR
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Dates
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Enumeration Date | 09/02/2014
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Last Update Date | 09/02/2014
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Provider Practice Location Address
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Address Line | 4401 SANTA ANITA AVE
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City | EL MONTE
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State | CA
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Zip | 91731-1611
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Country | US
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Telephone | 626-241-0008
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Fax |
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Provider Business Mailing Address
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Address Line | 300 ABERY AVE
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City | LA PUENTE
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State | CA
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Zip | 91744-6101
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Country | US
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Telephone | 626-241-0008
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Fax |
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Authorized Official
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Title or Position | CHILD FAMILY SERVICES
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Name | MR. ABRAHAM CORTEZ JR.
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Credential | B.A.
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Telephone | 626-241-0008
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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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