Basic Information
| Provider Information | |||||||||
| NPI: | 1043694052 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | LOS ANGELES CENTERS FOR ALCOHOL AND DRUG ABUSE | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | L.A. CADA | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11015 BLOOMFIELD AVE | ||||||||
| Address2: | |||||||||
| City: | SANTA FE SPRINGS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906704601 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 9515 HANEY ST | ||||||||
| Address2: | ROOM 7 | ||||||||
| City: | PICO RIVERA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906603622 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5629062676 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/20/2015 | ||||||||
| LastUpdateDate: | 07/20/2015 | ||||||||
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| AuthorizedOfficialLastName: | NAVARRO | ||||||||
| AuthorizedOfficialFirstName: | JUAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | ACTING EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 5629062686 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251B00000X | 190100BN | CA | Y | Agencies | Case Management |
ID Information
| ID | Type | State | Issuer | Description | MEDICAL PROVIDER NUM | 01 | CA | 1937 | OTHER |