Individual
ROCCOYA OCTAVIA EDWARDS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
12021 WILMINGTON AVE STE 102, LOS ANGELES, CA 90059-3019
(424) 454-6001
Mailing address
12021 WILMINGTON AVE STE 102, LOS ANGELES, CA 90059-3019
(424) 454-6001
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Enumeration date
06/02/2023
Last updated
06/02/2023
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