MEDICARE: REBUILD CALIFORNIA ALLIANCE

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	:	1528229879
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REBUILD CALIFORNIA ALLIANCE

Provider Business Mailing Address
First Line	:	7622 AVALON BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90003-2326
Country	:	US
Telephone Number	:	323-422-1124
Fax Number	:	323-920-7380

Provider Business Practice Location Address
First Line	:	145 W 99TH ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90003-4114
Country	:	US
Telephone Number	:	323-422-1124
Fax Number	:	323-531-4063

Authorized Official
Title or Position	:	FOUNDER
Name	:	DEANTWAN MARQUIS FITTS
Credential	:
Telephone Number	:	323-422-1124

Provider Enumeration Date	:	06/19/2008
Last Update Date	:	04/08/2026

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Directions to “REBUILD CALIFORNIA ALLIANCE ” Practice Location

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