Provider Demographics
NPI:1770906117
Name:CITRUS TREATMENT CENTER
Entity type:Organization
Organization Name:CITRUS TREATMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:LEBERTHON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-373-2333
Mailing Address - Street 1:1135 S SUNSET AVE
Mailing Address - Street 2:SUITE # 207
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-3937
Mailing Address - Country:US
Mailing Address - Phone:626-373-2333
Mailing Address - Fax:626-549-4603
Practice Address - Street 1:1135 S SUNSET AVE
Practice Address - Street 2:SUITE # 207
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-3937
Practice Address - Country:US
Practice Address - Phone:626-373-2333
Practice Address - Fax:626-549-4603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-21
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QI0500X, 261QP2300X
CAG79934261QX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
No261QX0200XAmbulatory Health Care FacilitiesClinic/CenterOncology