Basic Information
| Provider Information | |||||||||
| NPI: | 1033248257 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GATEWAYS NORMANDIE VILLAGE EAST OUTPATIENT CLINIC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1891 EFFIE STREET | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3236442000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1338 S GRAND AVE | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900153009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2133895820 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/05/2007 | ||||||||
| LastUpdateDate: | 05/05/2016 | ||||||||
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| AuthorizedOfficialLastName: | PELSMAN | ||||||||
| AuthorizedOfficialFirstName: | MARA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 3236442000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0801X | 930000058 | CA | Y | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
No ID Information.