Organization
LOS ANGELES COUNTY - RESEDA MTU
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WESLEY FORD (DIRECTOR, CMS)
(626) 569-6001
Entity
Organization
Contact information
Practice address
19451 WYANDOTTE ST, RESEDA, CA 91335-3518
(818) 885-6244
Mailing address
9320 TELSTAR AVE STE 226, EL MONTE, CA 91731-2849
Taxonomy
Speciality
Code
Description
License number
State
261QR0400X
Rehabilitation Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
CCS00021F
—
CA
Enumeration date
01/24/2007
Last updated
01/25/2010
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