Organization
AZUSA PACIFIC UNIVERSITY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK DICKERSON (VICE PRESIDENT)
(626) 387-5763
Entity
Organization
Contact information
Practice address
918 E ALOSTA AVE, AZUSA, CA 91702-2709
(626) 815-5421
Mailing address
901 E ALOSTA AVE, AZUSA, CA 91702-2701
(626) 815-5421
(626) 815-5015
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
252Y00000X
Early Intervention Provider Agency
—
—
Other
Enumeration date
01/19/2008
Last updated
01/19/2008
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