Provider Demographics
NPI:1518097229
Name:ASIAN AMERICAN DRUG ABUSE PROGRAM, INC
Entity Type:Organization
Organization Name:ASIAN AMERICAN DRUG ABUSE PROGRAM, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERIM PROGRAM DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORETHA
Authorized Official - Middle Name:
Authorized Official - Last Name:VILLALOBOS
Authorized Official - Suffix:
Authorized Official - Credentials:CAS
Authorized Official - Phone:323-294-4932
Mailing Address - Street 1:2900 S CRENSHAW BLVD.
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90016
Mailing Address - Country:US
Mailing Address - Phone:323-293-6284
Mailing Address - Fax:323-295-4075
Practice Address - Street 1:1088 S. LA BREA AVE.
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90019
Practice Address - Country:US
Practice Address - Phone:323-295-0262
Practice Address - Fax:323-295-2375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2017-11-21
Deactivation Date:2013-09-10
Deactivation Code:
Reactivation Date:2015-10-08
Provider Licenses
StateLicense IDTaxonomies
CA6947251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6947OtherCERTIFICATION NUMBER