Organization
DEPARTMENT OF MENTAL HEALTH, LA COUNTY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARVIN SOUTHARD DSW (DIRECTOR OF MENTAL HEALTH)
(213) 430-6700
Entity
Organization
Contact information
Practice address
4067 W 3RD ST APT 106, LOS ANGELES, CA 90020-3168
(213) 807-4639
Mailing address
4067 W. 3RD ST, #106, LOS ANGELES, CA 90020
(213) 807-4639
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
D05195986
AZ
305S00000X
Point of Service
Primary
MANTELA352PR
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
D05195986
ARIZONA IDENTIFICATION CARD
AZ
Enumeration date
03/11/2010
Last updated
03/11/2010
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