| NPI | 1326684259 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEREMY REVELL Owner/Provider 323-216-0993 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry |
| Additional Taxonomies | 2084A0401X Psychiatry & Neurology Addiction Medicine |
| 2084B0002X Psychiatry & Neurology Obesity Medicine | |
| 2084P0005X Psychiatry & Neurology Neurodevelopmental Disabilities | |
| 2084P0804X Psychiatry & Neurology Child & Adolescent Psychiatry | |
| 2084P0805X Psychiatry & Neurology Geriatric Psychiatry | |
| 2084P2900X Psychiatry & Neurology Pain Medicine | |
| 2084S0010X Psychiatry & Neurology Sports Medicine | |
| Enumeration Date | 2019-11-26 |
| Last Update Date | 2019-11-26 |