| NPI | 1245014836 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ITALIA TALLEY Owner 310-270-0968 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2023-08-23 |
| Last Update Date | 2023-09-07 |