Provider Demographics
NPI:1528234440
Name:PACIFIC ASIAN ALCOHOL AND DRUG PROGRAM
Entity type:Organization
Organization Name:PACIFIC ASIAN ALCOHOL AND DRUG PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LEO
Authorized Official - Middle Name:P
Authorized Official - Last Name:PANDAC
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:213-413-1622
Mailing Address - Street 1:2001 BEVERLY BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057-2400
Mailing Address - Country:US
Mailing Address - Phone:213-413-1622
Mailing Address - Fax:213-413-5456
Practice Address - Street 1:2001 BEVERLY BLVD STE 201
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-2400
Practice Address - Country:US
Practice Address - Phone:213-413-1622
Practice Address - Fax:213-413-5456
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SPECIAL SERVICE FOR GROUPS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-30
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA190210CN251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA190210CNOtherCERTIFICATION FROM CALIFORNIA STATE ALCOHOL AND DRUG PROGRAMS