MEDICARE: CARMEN CONDON

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	101YM0800X	Mental Health Counselor
2	225400000X	Rehabilitation Practitioner	CA
3	171M00000X	Case Manager/Care Coordinator	CA

General Provider Information

NPI Number	:	1619355369
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARMEN CONDON

Provider Business Mailing Address
First Line	:	6330 RUGBY AVE
Second Line	:
City	:	HUNTINGTON PARK
State	:	CA
Zip	:	90255-4066
Country	:	US
Telephone Number	:	213-222-3804
Fax Number	:

Provider Business Practice Location Address
First Line	:	11303 W WASHINGTON BLVD STE 027
Second Line	:
City	:	CULVER CITY
State	:	CA
Zip	:	90066-6003
Country	:	US
Telephone Number	:	310-486-6667
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/14/2015
Last Update Date	:	02/10/2026

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Directions to “ CARMEN CONDON ” Practice Location

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