Provider Demographics
NPI:1275707366
Name:LOS ANGELES COUNTY PROBATION
Entity Type:Organization
Organization Name:LOS ANGELES COUNTY PROBATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STAFF ASSISTANT
Authorized Official - Prefix:MR
Authorized Official - First Name:DEJAUN
Authorized Official - Middle Name:
Authorized Official - Last Name:BLEDSOE
Authorized Official - Suffix:
Authorized Official - Credentials:ADULT FIELD SERVICES
Authorized Official - Phone:562-940-3694
Mailing Address - Street 1:10028 WISNER AVE
Mailing Address - Street 2:
Mailing Address - City:MISSION HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91345-3037
Mailing Address - Country:US
Mailing Address - Phone:818-891-4347
Mailing Address - Fax:
Practice Address - Street 1:10028 WISNER AVE
Practice Address - Street 2:
Practice Address - City:MISSION HILLS
Practice Address - State:CA
Practice Address - Zip Code:91345-3037
Practice Address - Country:US
Practice Address - Phone:818-891-4347
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-18
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA171M00000X305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA171M00000XOtherLOS ANGELES COUNTY PROBAT