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General NPI Number Information
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NPI Number | 1801243266
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Entity Type | Organization
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Legal Business Name | LIFE QUESTS LLC
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Dates
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Enumeration Date | 05/16/2016
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Last Update Date | 05/16/2016
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Provider Practice Location Address
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Address Line | 1315 BULLIS RD, #16
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City | COMPTON
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State | CA
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Zip | 90221-1652
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Country | US
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Telephone | 818-284-7464
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Fax |
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Provider Business Mailing Address
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Address Line | 1315 BULLIS RD, #16
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City | COMPTON
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State | CA
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Zip | 90221-1652
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Country | US
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Telephone | 818-284-7464
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. TS RAJAN
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Credential |
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Telephone | 818-284-7464
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2800X
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Taxonomy Name | Methadone Clinic
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License Number | A26101
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License Number State | CA
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