| NPI | 1043656887 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THAIPHONG THANH VO Credentialing Supervisor 818-206-0360 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2800X Clinic/Center, Methadone Clinic |
| Enumeration Date | 2013-05-20 |
| Last Update Date | 2023-03-08 |