Individual
AFIF W DEMACHKIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1149 W 190TH ST STE 2200, GARDENA, CA 90248-4344
(310) 856-0800
(855) 568-2494
Mailing address
18726 S WESTERN AVE STE 408, GARDENA, CA 90248-3858
(310) 856-0800
(855) 568-2494
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
21169166
CA
Other
Enumeration date
12/01/2020
Last updated
09/30/2021
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