Organization
RENEW INTEGRATED PROGRAM-2 INCORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAJA I IBRAHEEM MD (OWNER)
(562) 426-3300
Entity
Organization
Contact information
Practice address
928 SOUTH PALOS VERDES STREET, SAN PEDRO, CA 90731
(562) 426-3300
(562) 637-3244
Mailing address
PO BOX 20140, LONG BEACH, CA 90801-3140
(562) 426-3300
(562) 637-3244
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
190484BP
CA
Other
Enumeration date
06/01/2007
Last updated
04/19/2010
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