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Organization

TETRA HEALTH CARE

Active
Organization subpart
No

Provider details

NPI number
Authorized official
GERALDINE LISE ESSOMBE BCBA (BCBA)
(310) 925-5542
Entity
Organization

Contact information

Practice address
10714 WOODBINE ST APT 4, LOS ANGELES, CA 90034-5423
(310) 925-5542
Mailing address
10714 WOODBINE ST APT 4, LOS ANGELES, CA 90034-5423
(310) 925-5542

Taxonomy

Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1700331956
CA
Enumeration date
11/15/2018
Last updated
11/15/2018
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