Basic Information
| Provider Information | |||||||||
| NPI: | 1740554443 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CALIFORINA HISPANIC COMMISSION ON ALCOHOL AND DRUG ABUSE | ||||||||
| LastName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | LATINO FAMILY CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3316-3320 W. BEVERLY BLVD. | ||||||||
| Address2: | |||||||||
| City: | MONTEBELLO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906401537 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3237224529 | ||||||||
| FaxNumber: | 3237224450 | ||||||||
| Practice Location | |||||||||
| Address1: | 3316-3320 W. BEVERLY BLVD. | ||||||||
| Address2: | |||||||||
| City: | MONTEBELLO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906401537 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3237224529 | ||||||||
| FaxNumber: | 3237224450 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/28/2012 | ||||||||
| LastUpdateDate: | 10/30/2013 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | DUPLESSIS | ||||||||
| AuthorizedOfficialFirstName: | GERMEEN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PROJECT DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 3237224529 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
ID Information
| ID | Type | State | Issuer | Description | 02768010 | 01 | CA | DRUG MEDI-CAL | OTHER |