NPI 1124396031

Wings of Refuge

Organisation Exclusive Provider Organization Los Angeles, CA

Practice location

Address: 4650 W Olympic Blvd, Los Angeles, CA 90019-1831
Phone: (323) 900-2700
Fax: (323) 936-8455
Mailing address: 5777 W Century Blvd Suite 910, Los Angeles, CA 90045-5600

Authorised official

Name: Renee G Moncito
Title: President & Ceo
Phone: (310) 670-6767

Registered specialties

Exclusive Provider Organization Primary

Managed Care Organizations Taxonomy 302F00000X

Other Exclusive Provider Organization providers in California →

Registry record

NPI: 1124396031
Entity type: Organization
NPI issued: 6 Dec 2011
Record last updated: 6 Dec 2011

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.