| Dragonfly Holding Llc | |
|
4201 Torrance Blvd Ste 720 Torrance CA 90503-4506 | |
| (310) 571-5957 | |
| Not Available |
| Full Name | Dragonfly Holding Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 4201 Torrance Blvd Ste 720, Torrance, California |
| Authorized Official Name and Position | Rishi Khatri (ADMINISTRATOR) |
| Authorized Official Contact | 3105715957 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dragonfly Holding Llc 4201 Torrance Blvd Ste 720 Torrance CA 90503-4506 Ph: (310) 571-5957 | Dragonfly Holding Llc 4201 Torrance Blvd Ste 720 Torrance CA 90503-4506 Ph: (310) 571-5957 |
| NPI Number | 1982175345 |
|---|---|
| Provider Enumeration Date | 12/11/2018 |
| Last Update Date | 10/05/2023 |
| Certification Date | 10/05/2023 |
| Medicare PECOS PAC ID | 1557788908 |
|---|---|
| Medicare Enrollment ID | O20200831001016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982175345 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
| 261QR0405X | Clinic/center - Rehabilitation, Substance Use Disorder | (* (Not Available)) | Secondary |
| Provider Name | Tanya Jennette Smit |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023520004 PECOS PAC ID: 7113285875 Enrollment ID: I20171229001731 |
| Provider Name | Sandra K Cox |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1730135971 PECOS PAC ID: 2163489246 Enrollment ID: I20201022004257 |
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