MEDICARE: CALIFORINA HISPANIC COMMISSION ON ALCOHOL AND DRUG ABUSE

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	02768010	OTHER	CA	DRUG MEDI-CAL

General Provider Information

NPI Number	:	1740554443
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CALIFORINA HISPANIC COMMISSION ON ALCOHOL AND DRUG ABUSE

Provider Business Mailing Address
First Line	:	3316-3320 W. BEVERLY BLVD.
Second Line	:
City	:	MONTEBELLO
State	:	CA
Zip	:	90640-1537
Country	:	US
Telephone Number	:	323-722-4529
Fax Number	:	323-722-4450

Provider Business Practice Location Address
First Line	:	3316-3320 W. BEVERLY BLVD.
Second Line	:
City	:	MONTEBELLO
State	:	CA
Zip	:	90640-1537
Country	:	US
Telephone Number	:	323-722-4529
Fax Number	:	323-722-4450

Authorized Official
Title or Position	:	PROJECT DIRECTOR
Name	:	MRS. GERMEEN DUPLESSIS
Credential	:
Telephone Number	:	323-722-4529

Provider Enumeration Date	:	02/28/2012
Last Update Date	:	10/30/2013

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