Provider Demographics
NPI:1134443880
Name:WEST COAST DRUG AND ALCOHOL EDUCATION PROGRAM
Entity type:Organization
Organization Name:WEST COAST DRUG AND ALCOHOL EDUCATION PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:UMUKORO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-619-3394
Mailing Address - Street 1:1055 W COLUMBIA WAY
Mailing Address - Street 2:STE 107
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-8155
Mailing Address - Country:US
Mailing Address - Phone:562-619-3394
Mailing Address - Fax:
Practice Address - Street 1:1055 W COLUMBIA WAY
Practice Address - Street 2:STE 107
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-8155
Practice Address - Country:US
Practice Address - Phone:562-619-3394
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-24
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization