Healthcare Provider Details

I. General information

NPI: 1639321607
Provider Name (Legal Business Name): CONNIE HAWTHORNE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2008
Last Update Date: 10/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6055 E WASHINGTON BLVD 900
COMMERCE CA
90040-2449
US

IV. Provider business mailing address

209 HAMPDEN TER
ALHAMBRA CA
91801-2910
US

V. Phone/Fax

Practice location:
  • Phone: 323-346-0960
  • Fax: 323-346-0966
Mailing address:
  • Phone: 626-308-9396
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: