11821 Foothill Blvd

NPI 1164767356 - Counselor - 101YA0400X

NPI Details
NPI 1164767356
Enumeration Date 11/29/2012
Last Updated 11/29/2012
Entity Type Healthcare Provider
Active Over 4 years ago
Authorized Information
Name DERRICK BRADLEY DERRICK
Position COUNSELOR
Phone (818) 694-7206
Fax
Practice Location
5436 S. BROADWAY
LOS ANGELES CA, 90037, US
Phone (818) 694-7206
Fax
Business Location
11821 FOOTHILL BLVD # K35
LAKE VIEW TERRACE CA, 91342-7200, US
Phone (818) 694-7206
Fax
Toxanomy
Taxonomy Code 101YA0400X
License State
License Number
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According to our database, 11821 Foothill Blvd NPI is 1164767356, taxonomy code is 101YA0400X 11821 Foothill Blvd physically located at 5436 S. Broadway, Los Angeles CA, 90037. NPI Number 1033115704 has the healthcare provider type.

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1164767356 NPI number is provided on an as is basis without warranty of any kind. 1164767356 is maintained by the National Plan & Provider Enumeration System. The contents of 11821 Foothill Blvd are for informational purposes only.