Healthcare Provider Details

I. General information

NPI: 1205761103
Provider Name (Legal Business Name): ROSE ANN SLAGLE CHW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 E KELSO ST
INGLEWOOD CA
90301-2703
US

IV. Provider business mailing address

340 E KELSO ST
INGLEWOOD CA
90301-2703
US

V. Phone/Fax

Practice location:
  • Phone: 323-645-1536
  • Fax:
Mailing address:
  • Phone: 323-645-1536
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License NumberCHW
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: