Healthcare Provider Details

I. General information

NPI: 1386344158
Provider Name (Legal Business Name): FT KNOX
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2023
Last Update Date: 03/09/2023
Certification Date: 03/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16332 E EDNA PL
COVINA CA
91722-2328
US

IV. Provider business mailing address

288 W TERRACE ST
ALTADENA CA
91001-4706
US

V. Phone/Fax

Practice location:
  • Phone: 626-394-1461
  • Fax:
Mailing address:
  • Phone: 626-394-1461
  • Fax: 323-998-7614

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: LATONDA KNOX
Title or Position: CEO
Credential: RN
Phone: 626-394-1461