MEDICARE: ODALYZ ABREO

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	390200000	CA

General Provider Information

NPI Number	:	1801401005
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ODALYZ ABREO

Provider Business Mailing Address
First Line	:	3035 GLENN AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90023-2712
Country	:	US
Telephone Number	:	323-875-8648
Fax Number	:	323-875-8648

Provider Business Practice Location Address
First Line	:	12021 WILMINGTON AVE STE 301
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90059-3019
Country	:	US
Telephone Number	:	888-777-8565
Fax Number	:

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

Provider Enumeration Date	:	09/14/2020
Last Update Date	:	03/16/2026

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Directions to “ ODALYZ ABREO ” Practice Location

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