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1245046291
GAVIN ULRIC ANDERSON
LOS ANGELES, CA
NPI
1245046291
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: CA R1568440724)
Enumeration Date
2024-12-04
Last Update Date
2024-12-04
Business Address
GAVIN ULRIC ANDERSON
2521 LONG BEACH AVE
LOS ANGELES, CA 90058-1324
Phone number: 760-905-8063
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Mailing Address
GAVIN ULRIC ANDERSON
786 MIRAFLORES
SAN PEDRO, CA 90731-1460
Phone number: 760-905-8063
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