Organization
PEDIATRIC MINDS MEDICAL CENTER
Active
Other names
Early Childhood Treatment Center
Organization subpart
No
Provider details
NPI number
Authorized official
MARIA APODACA (ACCOUNT REPRESENTATIVE)
(424) 206-1919
Entity
Organization
Contact information
Practice address
3524 TORRANCE BLVD, SUITE 103, TORRANCE, CA 90503-4821
(310) 540-1630
(310) 543-0400
Mailing address
3524 TORRANCE BLVD, SUITE 103, TORRANCE, CA 90503-4821
(310) 540-1630
(310) 543-0400
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
—
—
103TC2200X
Clinical Child & Adolescent Psychologist
—
—
103TM1800X
Intellectual & Developmental Disabilities Psychologist
—
—
103TP2701X
Group Psychotherapy Psychologist
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
A78624
CA
Other
Enumeration date
07/28/2010
Last updated
09/17/2010
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