Organization
SAFE IPC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LARRY WEISS ESQ. (GENERAL COUNSEL)
(415) 310-0801
Entity
Organization
Contact information
Practice address
1639 11TH ST STE 200, SANTA MONICA, CA 90404-3729
(415) 310-0801
Mailing address
841 S CLOVERDALE AVE, LOS ANGELES, CA 90036-4818
(917) 373-9448
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
—
—
251K00000X
Public Health or Welfare Agency
—
—
261Q00000X
Clinic/Center
Primary
—
—
261QC1500X
Community Health Clinic/Center
—
—
261QP0905X
State or Local Public Health Clinic/Center
—
—
261QP2300X
Primary Care Clinic/Center
—
—
261QR1100X
Research Clinic/Center
—
—
261QS1000X
Student Health Clinic/Center
—
—
Other
Enumeration date
06/20/2017
Last updated
06/20/2017
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