Provider Demographics
NPI:1275753311
Name:MASHA, SYLVESTER NWANDIMGBU
Entity Type:Individual
Prefix:MR
First Name:SYLVESTER
Middle Name:NWANDIMGBU
Last Name:MASHA
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:PATRICK
Other - Middle Name:NWANDIMGBU
Other - Last Name:MASHA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 561722
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90056-0240
Mailing Address - Country:US
Mailing Address - Phone:323-252-7442
Mailing Address - Fax:323-294-6400
Practice Address - Street 1:4041 MARLTON AVE
Practice Address - Street 2:SUITE 136
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90008-2519
Practice Address - Country:US
Practice Address - Phone:323-294-6400
Practice Address - Fax:323-294-6400
Is Sole Proprietor?:No
Enumeration Date:2007-04-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)