MEDICARE: EL CENTRO DE AMISTAD, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1134574973
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EL CENTRO DE AMISTAD, INC

Provider Business Mailing Address
First Line	:	8399 TOPANGA CANYON BLVD
Second Line	:	SUITE 303
City	:	CANOGA PARK
State	:	CA
Zip	:	91304-2354
Country	:	US
Telephone Number	:	818-347-8565
Fax Number	:

Provider Business Practice Location Address
First Line	:	8399 TOPANGA CANYON BLVD
Second Line	:	SUITE 303
City	:	CANOGA PARK
State	:	CA
Zip	:	91304-2354
Country	:	US
Telephone Number	:	818-347-8565
Fax Number	:

Authorized Official
Title or Position	:	INFORMATION SYSTEMS SUPERVISOR
Name	:	MRS. CARLA ESPINOZA BAIRES
Credential	:
Telephone Number	:	818-898-0223

Provider Enumeration Date	:	04/29/2016
Last Update Date	:	11/21/2022

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