Organization
VIA AVANTA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MAYLI EUNICE TORRES (ASSISTANT COUNSLER)
(818) 561-9415
Entity
Organization
Contact information
Practice address
4760 SEPULVEDA BLVD, CULVER CITY, CA 90230
(310) 390-6612
Mailing address
4760 SEPULVEDA BLVD, CULVER CITY, CA 90230
(310) 390-6612
Taxonomy
Speciality
Code
Description
License number
State
261QC1500X
Community Health Clinic/Center
Primary
172V00000X
CA
Other
Enumeration date
03/13/2017
Last updated
03/13/2017
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