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5400 E. Olympic Blvd Suite 100 Commerce CA 90022-5190 | |
(213) 785-5906 | |
(213) 785-5928 |
Full Name | |
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Speciality | Clinic/center - Rehabilitation, Substance Use Disorder |
Location | 5400 E. Olympic Blvd Suite 100, Commerce, California |
Authorized Official Name and Position | Marisol M Lara (QA MANAGER ADMINISTRATOR) |
Authorized Official Contact | 3232542274 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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5400 E. Olympic Blvd Suite 100 Commerce CA 90022-5190 Ph: (213) 785-5906 | 5400 E. Olympic Blvd Suite 100 Commerce CA 90022-5190 Ph: (213) 785-5906 |
NPI Number | 1972047165 |
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Provider Enumeration Date | 12/07/2016 |
Last Update Date | 11/06/2024 |
Certification Date | 11/06/2024 |
Identifier | Type | State | Issuer |
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1972047165 | NPI | - | NPPES |
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