Organization
DUAL DIAGNOSIS ASSESSMENT AND TREATMENT CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EDNA MILLER (DIRECTOR)
(310) 590-4537
Entity
Organization
Contact information
Practice address
2265 E 103RD ST, LOS ANGELES, CA 90002-3132
(310) 590-4537
(310) 590-4538
Mailing address
19300 RINALDI ST, STE. 8270, NORTHRIDGE, CA 91326-1651
(310) 590-4537
(310) 590-4538
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CMM71096F
MEDI-CAL
CA
Enumeration date
05/25/2010
Last updated
05/25/2010
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