Provider Demographics
NPI:1740554443
Name:CALIFORINA HISPANIC COMMISSION ON ALCOHOL AND DRUG ABUSE
Entity type:Organization
Organization Name:CALIFORINA HISPANIC COMMISSION ON ALCOHOL AND DRUG ABUSE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROJECT DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:GERMEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:DUPLESSIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-722-4529
Mailing Address - Street 1:3316-3320 W. BEVERLY BLVD.
Mailing Address - Street 2:
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-1537
Mailing Address - Country:US
Mailing Address - Phone:323-722-4529
Mailing Address - Fax:323-722-4450
Practice Address - Street 1:3316-3320 W. BEVERLY BLVD.
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-1537
Practice Address - Country:US
Practice Address - Phone:323-722-4529
Practice Address - Fax:323-722-4450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-28
Last Update Date:2013-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA02768010OtherDRUG MEDI-CAL