Healthcare Provider Details

I. General information

NPI: 1811545635
Provider Name (Legal Business Name): DA VINCI DESIGN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2019
Last Update Date: 05/20/2021
Certification Date: 05/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 N DOUGLAS ST
EL SEGUNDO CA
90245-4637
US

IV. Provider business mailing address

201 N DOUGLAS ST
EL SEGUNDO CA
90245-4637
US

V. Phone/Fax

Practice location:
  • Phone: 310-725-5800
  • Fax:
Mailing address:
  • Phone: 310-725-5800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. CHUCK A MUIRHEAD
Title or Position: CONSULTANT
Credential:
Phone: 951-310-4976