Organization
WINGS OF REFUGE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RENEE MONCITO (CEO)
(310) 670-6767
Entity
Organization
Contact information
Practice address
5777 W CENTURY BLVD, STE 910, LOS ANGELES, CA 90045-5600
(310) 670-6767
(310) 670-2626
Mailing address
5777 W CENTURY BLVD, STE 910, LOS ANGELES, CA 90045-5600
(310) 670-6767
(310) 670-2626
Taxonomy
Speciality
Code
Description
License number
State
251300000X
Local Education Agency (LEA)
Primary
190434AN
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
197098
MEDI-CAL PROVIDER
CA
Enumeration date
04/19/2007
Last updated
08/22/2020
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