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NPI Code Detail

MEDICARE: DEIDRE COLLINS B.A.

MEDICARE:   DEIDRE  COLLINS  B.A.
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
1101Y00000XCounselor

General Provider Information

NPI Number : 1538299458
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEIDRE COLLINS B.A.
Provider Business Mailing Address
First Line : 5302 W 93RD ST
Second Line : #5
City : LOS ANGELES
State : CA
Zip : 90045-7376
Country : US
Telephone Number : 310-365-8721
Fax Number :
Provider Business Practice Location Address
First Line : 5302 W 93RD ST
Second Line : #5
City : LOS ANGELES
State : CA
Zip : 90045-7376
Country : US
Telephone Number : 310-365-8721
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/07/2007
Last Update Date : 07/08/2007

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Directions to “ DEIDRE COLLINS B.A.” Practice Location

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