MEDICARE: ZINNIA COMMUNITY CARE CLINIC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	364SC1501X	Community Health/Public Health Clinical Nurse Specialist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	95000601	OTHER	CA	NURSE PRACTIONER

General Provider Information

NPI Number	:	1609335181
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ZINNIA COMMUNITY CARE CLINIC

Provider Business Mailing Address
First Line	:	2917 W VERNON AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90008-4714
Country	:	US
Telephone Number	:	909-573-7092
Fax Number	:

Provider Business Practice Location Address
First Line	:	2917 W VERNON AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90008-4714
Country	:	US
Telephone Number	:	909-573-7092
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	TOYIN KUYORO
Credential	:	NP
Telephone Number	:	909-573-7092

Provider Enumeration Date	:	03/14/2019
Last Update Date	:	03/14/2019

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