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1780225532
FUMIKO IRENE FUKUMOTO GONZALES
LOS ANGELES, CA
NPI
1780225532
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
Enumeration Date
2019-10-02
Last Update Date
2019-10-02
Business Address
FUMIKO IRENE FUKUMOTO GONZALES RADT
5318 CRENSHAW BLVD
LOS ANGELES, CA 90043-1810
Phone number: 323-293-6291
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Mailing Address
FUMIKO IRENE FUKUMOTO GONZALES RADT
1300 SARATOGA AVE UNIT 609
VENTURA, CA 93003-6406
Phone number: 424-404-2437
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