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NPI Code Detail

MEDICARE: MR. JOHN MABO RAS

MEDICARE: MR. JOHN MABO RAS
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) CounselorRI-M1209141145CA

General Provider Information

NPI Number : 1700256963
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JOHN MABO RAS
Provider Business Mailing Address
First Line : 600 W MANCHESTER AVE
Second Line : 5
City : LOS ANGELES
State : CA
Zip : 90044-5770
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 600 W MANCHESTER AVE
Second Line : 5
City : LOS ANGELES
State : CA
Zip : 90044-5770
Country : US
Telephone Number : 323-750-9247
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/30/2015
Last Update Date : 09/30/2015

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