Basic Information
| Provider Information | |||||||||
| NPI: | 1356410765 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HOLLYWOOD MENTA HEALTH CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12747 RIVERSIDE DR | ||||||||
| Address2: | |||||||||
| City: | VALLEY VILLAGE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 916073300 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1224 VINE ST | ||||||||
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| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900381612 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3237696100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/07/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | CIENFUEGOS | ||||||||
| AuthorizedOfficialFirstName: | BARBARA | ||||||||
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| AuthorizedOfficialTitleorPosition: | PROGRAM HEAD | ||||||||
| AuthorizedOfficialTelephone: | 3237696100 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.