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NPI Code Detail

MEDICARE: STEP UP ON SECOND STREET, INC.

MEDICARE: STEP UP ON SECOND STREET, INC.
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
1251S00000XCommunity/Behavioral Health Agency

General Provider Information

NPI Number : 1831228626
Entity Type Code : Organization
Provider Name (Legal Business Name) : STEP UP ON SECOND STREET, INC.
Provider Business Mailing Address
First Line : 1328 2ND ST
Second Line :
City : SANTA MONICA
State : CA
Zip : 90401-1122
Country : US
Telephone Number : 310-394-6889
Fax Number : 310-394-6883
Provider Business Practice Location Address
First Line : 1328 2ND ST
Second Line :
City : SANTA MONICA
State : CA
Zip : 90401-1122
Country : US
Telephone Number : 310-394-6889
Fax Number : 310-394-6883
Authorized Official
Title or Position : CEO
Name : MR. TOD LIPKA
Credential :
Telephone Number : 310-394-6889
Provider Enumeration Date : 03/05/2007
Last Update Date : 10/31/2012

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Directions to “STEP UP ON SECOND STREET, INC. ” Practice Location

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