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General NPI Number Information
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NPI Number | 1972908044
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Entity Type | Organization
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Legal Business Name | COMMUNITY SUPPORT CLINIC, INC.
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Dates
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Enumeration Date | 10/30/2014
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Last Update Date | 10/30/2014
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Provider Practice Location Address
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Address Line | 506 S SAN PEDRO ST SUITE A
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City | LOS ANGELES
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State | CA
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Zip | 90013-2102
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Country | US
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Telephone | 323-373-3350
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Fax | 323-373-3351
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Provider Business Mailing Address
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Address Line | 147 N SPARKS ST SUITE A
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City | BURBANK
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State | CA
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Zip | 91506-2143
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Country | US
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Telephone | 323-373-3350
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Fax | 323-373-3351
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Authorized Official
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Title or Position | OPERATIONS MANAGER
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Name | MARY MALEK
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Credential |
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Telephone | 323-373-3350
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0050X
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Taxonomy Name | Non-Surgical Family Planning Clinic/Center
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License Number |
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License Number State |
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