NPIMap

Organization Active NPI

Renew Integrated Program-2 Incorporation

  • Substance Use Disorder Rehabilitation Clinic/Center
  • San Pedro, CA
National Provider Identifier
1891997847
Registry record updated Apr 19, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X
License
190484BP Issued in CA
Legal business name
RENEW INTEGRATED PROGRAM-2 INCORPORATION
Practice address
928 South Palos Verdes Street
San Pedro, CA 90731
Phone
(562) 426-3300
Fax
(562) 637-3244
NPI assigned
Jun 1, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 19, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Laja I Ibraheem, MD
Title
Owner
Phone
(562) 426-3300

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X 190484BP CA Primary

Addresses

Primary practice location

928 South Palos Verdes Street
San Pedro, CA 90731

Mailing address

PO Box 20140
Long Beach, CA 90801-3140
Phone (562) 426-3300

National Provider Directory

National Provider Directory
Tax ID family
Renew Integrated Program-2 Inc26 organizations share this tax ID, including this one

Other organizations with this tax ID 25

Organizations that report the same tax identification number in the National Provider Directory.

View all 25

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1180656000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1271635200000",
    "number": "1891997847",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 20140",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908013140",
            "telephone_number": "562-426-3300",
            "fax_number": "562-637-3244"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "928 SOUTH PALOS VERDES STREET",
            "city": "SAN PEDRO",
            "state": "CA",
            "postal_code": "90731",
            "telephone_number": "562-426-3300",
            "fax_number": "562-637-3244"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RENEW INTEGRATED PROGRAM-2 INCORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-01",
        "last_updated": "2010-04-19",
        "status": "A",
        "authorized_official_last_name": "IBRAHEEM",
        "authorized_official_first_name": "LAJA",
        "authorized_official_middle_name": "I",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "562-426-3300",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "CA",
            "license": "190484BP",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Pedro, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.