Individual
CONGA SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4026 6TH AVE, LOS ANGELES, CA 90008-2733
(310) 614-1152
Mailing address
4026 6TH AVE, LOS ANGELES, CA 90008-2733
(310) 614-1152
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Enumeration date
08/13/2016
Last updated
08/13/2016
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