Provider Demographics
NPI:1538718531
Name:HARBOR-UCLA DMH
Entity type:Organization
Organization Name:HARBOR-UCLA DMH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERN
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:
Authorized Official - Last Name:WAKABAYASHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-295-6408
Mailing Address - Street 1:HARBOR-UCLA DMH
Mailing Address - Street 2:1000 W CARSON ST BOX #498
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90502
Mailing Address - Country:US
Mailing Address - Phone:424-306-5737
Mailing Address - Fax:
Practice Address - Street 1:HARBOR-UCLA DMH
Practice Address - Street 2:1000 W CARSON ST BOX #498
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90502
Practice Address - Country:US
Practice Address - Phone:424-306-5737
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-11
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty