Basic Information
| Provider Information | |||||||||
| NPI: | 1932238862 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THE DUBNOFF CENTER FOR CHILD DEVELOPMENT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10526 DUBNOFF WAY | ||||||||
| Address2: | |||||||||
| City: | NORTH HOLLYWOOD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 916063921 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8187554950 | ||||||||
| FaxNumber: | 8187520783 | ||||||||
| Practice Location | |||||||||
| Address1: | 11631 VICTORY BLVD STE 207 | ||||||||
| Address2: | |||||||||
| City: | NORTH HOLLYWOOD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 916063572 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8185586955 | ||||||||
| FaxNumber: | 8189722810 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/05/2007 | ||||||||
| LastUpdateDate: | 10/22/2010 | ||||||||
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| AuthorizedOfficialLastName: | STERNIG-BABCOCK | ||||||||
| AuthorizedOfficialFirstName: | SANDRA | ||||||||
| AuthorizedOfficialMiddleName: | H | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT AND CEO | ||||||||
| AuthorizedOfficialTelephone: | 8187554950 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PH.D. | ||||||||
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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 | 7571 | 05 | CA | MEDICAID |