Organization
CHILDREN'S BUREAU
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARTIN RIBIERO MFT (SUPERVISOR)
(213) 342-0000
Entity
Organization
Contact information
Practice address
1910 MAGNOLIA AVE, LOS ANGELES, CA 90007-1220
(213) 342-0100
Mailing address
1910 MAGNOLIA AVE, LOS ANGELES, CA 90007-1220
(213) 242-0100
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
21342
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7300
—
CA
Enumeration date
02/08/2010
Last updated
02/08/2010
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