1497888051 NPI number — CALIFORNIA INSTITUTE OF HEALTH & SOCIAL SERVICES, 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 1497888051 NPI number — CALIFORNIA INSTITUTE OF HEALTH & SOCIAL SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CALIFORNIA INSTITUTE OF HEALTH & SOCIAL SERVICES, 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:
6
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:
1497888051
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8929 S SEPULVEDA BLVD
Provider Second Line Business Mailing Address:
201
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90045-3616
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-645-5227
Provider Business Mailing Address Fax Number:
310-645-9840

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
555 W REDONDO BEACH BLVD # 215
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GARDENA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90248-1612
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-352-6422
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MARSHALL
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
T
Authorized Official Title or Position:
PRESIDENT/ CEO
Authorized Official Telephone Number:
310-645-5227

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , 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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