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General NPI Number Information
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NPI Number | 1770251902
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Entity Type | Organization
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Legal Business Name | IGCN HEALTH CENTER LLC
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Dates
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Enumeration Date | 09/02/2021
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Last Update Date | 09/02/2021
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Provider Practice Location Address
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Address Line | 6153 COLGATE AVE
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City | LOS ANGELES
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State | CA
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Zip | 90036-3127
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Country | US
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Telephone | 323-433-4165
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Fax |
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Provider Business Mailing Address
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Address Line | 6153 COLGATE AVE
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City | LOS ANGELES
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State | CA
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Zip | 90036-3127
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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 | CEO/CLINICAL DIRECTOR
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Name | MR. CAMERON NESBITT
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Credential | M.S., BCBA
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Telephone | 323-433-4165
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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