Provider Demographics
NPI:1679896781
Name:PLAZA COMMUNITY CENTER
Entity type:Organization
Organization Name:PLAZA COMMUNITY CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GABRIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BUELNA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:323-267-9749
Mailing Address - Street 1:4018 CITY TERRACE DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90063-1242
Mailing Address - Country:US
Mailing Address - Phone:323-267-9749
Mailing Address - Fax:323-267-0375
Practice Address - Street 1:5255 POMONA BLVD STE 5
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90022-1753
Practice Address - Country:US
Practice Address - Phone:323-888-2530
Practice Address - Fax:323-726-3510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-03
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty