1568603462 NPI number — CRENSHAW AREA OFFICE

Table of content: (NPI 1568603462)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568603462 NPI number — CRENSHAW AREA OFFICE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CRENSHAW AREA OFFICE
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:
1568603462
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3606 EXPOSITION BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90016-4822
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
323-298-3501
Provider Business Mailing Address Fax Number:
323-296-3049

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9150 IMPERIAL HWY RM P-31
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DOWNEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90242-2835
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-940-3694
Provider Business Practice Location Address Fax Number:
562-658-7425
Provider Enumeration Date:
03/23/2009

Additional Information

Authorized Official

Authorized Official Last Name:
JONES
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
EUGENE
Authorized Official Title or Position:
PROBATION OFFICER
Authorized Official Telephone Number:
323-298-3522

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X , 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)

  • Identifier: 171M00000X . This is a "'17'" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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