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General NPI Number Information
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NPI Number | 1881904050
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Entity Type | Organization
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Legal Business Name | OTHERS INTERNATIONAL, INC.
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Dates
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Enumeration Date | 10/20/2010
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Last Update Date | 10/20/2010
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Provider Practice Location Address
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Address Line | 375 S MAIN ST 226
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City | POMONA
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State | CA
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Zip | 91766-1624
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Country | US
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Telephone | 909-649-7261
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Fax |
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Provider Business Mailing Address
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Address Line | 101 W MISSION BLVD 110-141
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City | POMONA
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State | CA
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Zip | 91766-1711
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Country | US
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Telephone | 909-649-7261
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Fax | 909-796-2537
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Authorized Official
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Title or Position | PROGRAM COORDINATOR
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Name | MRS. SHIRLEY HUNT WIGGINS
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Credential |
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Telephone | 909-649-7261
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCS26590
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License Number State | CA
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