MEDICARE: DK FORTUNE & ASSOCIATES INC

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	313M00000X	Nursing Facility/Intermediate Care Facility		CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639102239
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DK FORTUNE & ASSOCIATES INC

Provider Business Mailing Address
First Line	:	5240 SEPULVEDA BLVD
Second Line	:
City	:	CULVER CITY
State	:	CA
Zip	:	90230
Country	:	US
Telephone Number	:	310-391-7266
Fax Number	:	310-397-4998

Provider Business Practice Location Address
First Line	:	5240 SEPULVEDA BLVD
Second Line	:
City	:	CULVER CITY
State	:	CA
Zip	:	90230
Country	:	US
Telephone Number	:	310-391-7266
Fax Number	:	310-397-4998

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MS. ROSIE VELASCO
Credential	:
Telephone Number	:	310-391-7266

Provider Enumeration Date	:	07/08/2006
Last Update Date	:	08/22/2020

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