Organization
LOS ANGELES COUNTY - SAN GABRIEL TU
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHAVONDA CHRISTMAS (ACTING DIRECTOR, CMS)
(626) 569-6001
Entity
Organization
Contact information
Practice address
600 E GRAND AVE, SAN GABRIEL, CA 91776-2817
(626) 614-2260
Mailing address
9320 TELSTAR AVE STE 226, EL MONTE, CA 91731-2816
(800) 288-4584
Taxonomy
Speciality
Code
Description
License number
State
261QR0400X
Rehabilitation Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
CCS00118F
—
CA
Enumeration date
10/10/2007
Last updated
10/10/2007
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