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NPI Code Detail

MEDICARE: RONALD FARRIS I RADT 1

MEDICARE: RONALD FARRIS I RADT 1
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
1101YA0400XAddiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number : 1558807685
Entity Type Code : Individual
Provider Name (Legal Business Name) : RONALD FARRIS I RADT 1
Provider Business Mailing Address
First Line : 1503 W 112TH ST
Second Line :
City : LOS ANGELES
State : CA
Zip : 90047-4928
Country : US
Telephone Number : 323-836-2001
Fax Number : 213-388-1317
Provider Business Practice Location Address
First Line : 155 BIMINI PL
Second Line :
City : LOS ANGELES
State : CA
Zip : 90004-5902
Country : US
Telephone Number : 213-388-5423
Fax Number : 213-388-1317
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/12/2017
Last Update Date : 01/12/2017

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Directions to “ RONALD FARRIS I RADT 1” Practice Location

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