Provider Demographics
NPI:1629677141
Name:AM EARLY INTERVENTION
Entity Type:Organization
Organization Name:AM EARLY INTERVENTION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALANA
Authorized Official - Middle Name:R
Authorized Official - Last Name:MOLINA
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:310-977-1923
Mailing Address - Street 1:310 S ALMONT DR APT 209
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-3756
Mailing Address - Country:US
Mailing Address - Phone:310-977-1923
Mailing Address - Fax:
Practice Address - Street 1:653 N CAHUENGA BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90004-1103
Practice Address - Country:US
Practice Address - Phone:323-469-8994
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-26
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency