Healthcare Provider Details

I. General information

NPI: 1558039446
Provider Name (Legal Business Name): SIYONE COLLINS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2021
Last Update Date: 09/03/2021
Certification Date: 09/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 W 190TH ST STE 300
GARDENA CA
90248-4925
US

IV. Provider business mailing address

1515 W 190TH ST STE 300
GARDENA CA
90248-4925
US

V. Phone/Fax

Practice location:
  • Phone: 310-819-4523
  • Fax: 877-394-6799
Mailing address:
  • Phone: 310-819-4523
  • Fax: 877-394-6799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberY2781023
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: