Provider Demographics
NPI:1417083049
Name:CHILDRENS BUREAU OF SOUTHERN CALIFORNIA
Entity Type:Organization
Organization Name:CHILDRENS BUREAU OF SOUTHERN CALIFORNIA
Other - Org Name:CHILDRENS BUREAU CARSON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:MORALES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:323-953-7350
Mailing Address - Street 1:460 E CARSON PLAZA DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90746-3228
Mailing Address - Country:US
Mailing Address - Phone:310-523-9500
Mailing Address - Fax:
Practice Address - Street 1:460 E CARSON PLAZA DR
Practice Address - Street 2:SUITE 102
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90746-3228
Practice Address - Country:US
Practice Address - Phone:310-523-9500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7570AOtherDMH REPORTING UNIT
CA00007570Medicaid
CA00668OtherDMH LEGAL ENITITY NUMBER