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Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. BAHBAH MAKOUIE (OWNER)
(310) 553-0432
Entity
Organization

Contact information

Practice address
11270 EXPOSITION BLVD, #642931, LOS ANGELES, CA 90064-5903
(310) 553-0432
(213) 402-2101
Mailing address
14717 HAWTHORNE BLVD, #B, LAWNDALE, CA 90260-1549
(310) 553-0432
(213) 402-2101

Taxonomy

Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
MFC 52448
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1437468782
NPI
CA
Enumeration date
02/27/2014
Last updated
02/27/2014
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