Basic Information
| Provider Information | |||||||||
| NPI: | 1134574973 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | EL CENTRO DE AMISTAD TOPANGA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8399 TOPANGA CANYON BLVD | ||||||||
| Address2: | SUITE 303 | ||||||||
| City: | CANOGA PARK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913042354 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8183478565 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8399 TOPANGA CANYON BLVD | ||||||||
| Address2: | SUITE 303 | ||||||||
| City: | CANOGA PARK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913042354 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8183478565 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/29/2016 | ||||||||
| LastUpdateDate: | 06/29/2016 | ||||||||
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| AuthorizedOfficialLastName: | FALLERT | ||||||||
| AuthorizedOfficialFirstName: | TANIA | ||||||||
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| AuthorizedOfficialTitleorPosition: | ASSOCIATE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 8183478565 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MFT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.