Provider Demographics
NPI:1124442850
Name:ASSISTANCE LEAGUE OF SAN PEDRO-SOUTH BAY
Entity type:Organization
Organization Name:ASSISTANCE LEAGUE OF SAN PEDRO-SOUTH BAY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-435-2624
Mailing Address - Street 1:1441 W 8TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90732-3803
Mailing Address - Country:US
Mailing Address - Phone:310-832-8355
Mailing Address - Fax:310-832-8460
Practice Address - Street 1:1441 W 8TH ST
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90732-3803
Practice Address - Country:US
Practice Address - Phone:310-832-8355
Practice Address - Fax:310-832-8460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-18
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental