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323 N Prairie Ave Suites 150, 290, 350, 450 Inglewood CA 90301-4502 | |
| (310) 677-7808 | |
| (310) 677-7205 |
| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 323 N Prairie Ave, Inglewood, California |
| Authorized Official Name and Position | Dulce M Ruiz (CONTRACTS & GRANTS MANAGER) |
| Authorized Official Contact | 3107515442 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
4760 Sepulveda Blvd Culver City CA 90230-4820 Ph: (310) 390-6612 | 323 N Prairie Ave Suites 150, 290, 350, 450 Inglewood CA 90301-4502 Ph: (310) 677-7808 |
| NPI Number | 1639200694 |
|---|---|
| Provider Enumeration Date | 03/08/2007 |
| Last Update Date | 10/06/2020 |
| Certification Date | 10/06/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639200694 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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