Provider Demographics
NPI:1508490012
Name:PERSIP, GENE
Entity Type:Individual
Prefix:MR
First Name:GENE
Middle Name:
Last Name:PERSIP
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5600 RICKENBACKER RD BLDG 2A-B
Mailing Address - Street 2:
Mailing Address - City:BELL
Mailing Address - State:CA
Mailing Address - Zip Code:90201-6467
Mailing Address - Country:US
Mailing Address - Phone:323-263-1206
Mailing Address - Fax:323-263-8543
Practice Address - Street 1:5600 RICKENBACKER RD BLDG 2A-B
Practice Address - Street 2:
Practice Address - City:BELL
Practice Address - State:CA
Practice Address - Zip Code:90201-6467
Practice Address - Country:US
Practice Address - Phone:323-263-1206
Practice Address - Fax:323-263-8543
Is Sole Proprietor?:No
Enumeration Date:2020-02-24
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)