1699910794 NPI number — WILSHIRE TREATMENT CENTER, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699910794 NPI number — WILSHIRE TREATMENT CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WILSHIRE TREATMENT CENTER, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699910794
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/04/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11901 SANTA MONICA BLVD
Provider Second Line Business Mailing Address:
STE. 204
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90025-2767
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-268-2446
Provider Business Mailing Address Fax Number:
310-479-0861

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11901 SANTA MONICA BLVD
Provider Second Line Business Practice Location Address:
STE. 204
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90025-2767
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-268-2446
Provider Business Practice Location Address Fax Number:
310-479-0861
Provider Enumeration Date:
12/04/2008

Additional Information

Authorized Official

Authorized Official Last Name:
KARIMI
Authorized Official First Name:
SHAHLA
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
310-268-2446

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  19133 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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