Provider Demographics
NPI:1689450207
Name:TAVA CLINICAL SERVICES OF CALIFORNIA, P.C.
Entity Type:Organization
Organization Name:TAVA CLINICAL SERVICES OF CALIFORNIA, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DALLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLRED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-319-6471
Mailing Address - Street 1:PO BOX 581406
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84158-1406
Mailing Address - Country:US
Mailing Address - Phone:385-406-2867
Mailing Address - Fax:801-992-8269
Practice Address - Street 1:700 S FLOWER ST STE 1000
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-4112
Practice Address - Country:US
Practice Address - Phone:323-825-6268
Practice Address - Fax:801-992-8269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-08
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)