Organization
INDEPENDENCE COMMUNITY TREATMENT CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALEX BRANZBURG (PROGRAM DIRECTOR)
(818) 776-1755
Entity
Organization
Contact information
Practice address
12450 VAN NUYS BLVD, PACOIMA, CA 91331-1391
(818) 776-1755
Mailing address
19231 VICTORY BLVD, SUITE 554, RESEDA, CA 91335-6308
Taxonomy
Speciality
Code
Description
License number
State
261QC1500X
Community Health Clinic/Center
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
CMM70956F
—
CA
Enumeration date
04/10/2007
Last updated
04/03/2008
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