Basic Information
| Provider Information | |||||||||
| NPI: | 1942497771 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | STAR BEHAVIORAL SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3411 HELMS AVE APT 1 | ||||||||
| Address2: | |||||||||
| City: | CULVER CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902322333 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3108770356 | ||||||||
| FaxNumber: | 3108378012 | ||||||||
| Practice Location | |||||||||
| Address1: | 370 CRENSHAW BLVD STE E100 | ||||||||
| Address2: | |||||||||
| City: | TORRANCE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 905031728 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3107871500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/25/2007 | ||||||||
| LastUpdateDate: | 09/26/2007 | ||||||||
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| AuthorizedOfficialLastName: | ZARAZUA | ||||||||
| AuthorizedOfficialFirstName: | DIANA | ||||||||
| AuthorizedOfficialMiddleName: | LINN | ||||||||
| AuthorizedOfficialTitleorPosition: | MENTAL HEALTH SPECIALIST II | ||||||||
| AuthorizedOfficialTelephone: | 3108770356 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | MA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | IMFT 50803 | CA | Y | Agencies | Community/Behavioral Health |
No ID Information.