Organization
ELYSIUM OUTPATIENT
Active
Other names
Outpatient Los Angeles
Organization subpart
No
Provider details
NPI number
Authorized official
CHERVINE RAZMAZMA (MANAGING MEMBER)
(408) 813-2323
Entity
Organization
Contact information
Practice address
10340 SANTA MONICA BLVD, LOS ANGELES, CA 90025-6904
(408) 813-2323
Mailing address
10340 SANTA MONICA BLVD, LOS ANGELES, CA 90025-6904
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
Other
Enumeration date
02/16/2021
Last updated
02/16/2021
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