Healthcare Provider Details

I. General information

NPI: 1215571666
Provider Name (Legal Business Name): DERNISHA SWEET
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2019
Last Update Date: 05/09/2025
Certification Date: 05/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3629 SANTA ANITA AVE STE 201
EL MONTE CA
91731-3635
US

IV. Provider business mailing address

8019 COMPTON AVE
LOS ANGELES CA
90001-3409
US

V. Phone/Fax

Practice location:
  • Phone: 626-993-3000
  • Fax:
Mailing address:
  • Phone: 323-586-7333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: