NEW FAITH TRANSITIONAL LIVING
Physician Assistant at Rosecrans Ave, Gardena, CA

License number
California 20AA5193
Category
Osteopathic Medicine
Type
Family Medicine
License number
California PA12545
Category
Nursing
Type
Physician Assistant
Owner
Name: ALICE BLACI
Title: PRESIDENT
Phone: (310) 436-7760
Address
Address
2233 W Rosecrans Ave, Gardena, CA 90249
National Provider ID: 1760868418
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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New Faith Transitional Living

Gardena, CA

Registration:
Jun 25, 2012
Addresses:
15507 S Normandie Ave, Gardena, CA 90247
839 W 167 St, Gardena, CA 90247
State ID:
03487143
Business type:
Articles of Incorporation
President:
Elaine Wynn (President)
Agent:
Dwayne Thompson

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