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1306444021
VANDA VA
LONG BEACH, CA
NPI
1306444021
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
Enumeration Date
2020-10-14
Last Update Date
2020-10-14
Business Address
VANDA VA
2501 ATLANTIC AVE
LONG BEACH, CA 90806-2708
Phone number: 562-424-6105
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Mailing Address
VANDA VA
PO BOX 16212
LONG BEACH, CA 90806-0712
Phone number: 562-418-4488
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