Provider Demographics
NPI:1194926022
Name:DREW CHILD DEVELOPMENT CORPORATION
Entity type:Organization
Organization Name:DREW CHILD DEVELOPMENT CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF MENTAL HEALTH & CHILD W
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:YVONNE
Authorized Official - Last Name:URIZAR
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:323-249-2950
Mailing Address - Street 1:1770 E. 118TH STREET
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90059-2518
Mailing Address - Country:US
Mailing Address - Phone:323-249-2950
Mailing Address - Fax:323-249-2970
Practice Address - Street 1:1770 E. 118TH STREET
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90059-2518
Practice Address - Country:US
Practice Address - Phone:323-249-2950
Practice Address - Fax:323-249-2970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA191593453251S00000X
CA1245407251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA01245407OtherMEDI-CAL PROVIDER ID #