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Organization
RENEW INTEGRATED PROGRAM-2
Active
Organization
RENEW INTEGRATED PROGRAM-2
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LAJA I IBRAHEEM MD (EXECUTIVE DIRECTOR)
(562) 426-3300
Entity
Organization
Contact information
Practice address
4000 LONG BEACH BLVD, 228, LONG BEACH, CA 90807-2617
(562) 426-3300
Mailing address
4000 LONG BEACH BLVD, 228, LONG BEACH, CA 90807-2617
(562) 426-3300
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
A66124
CA
Other
Enumeration date
03/09/2010
Last updated
03/09/2010
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