Healthcare Provider Details

I. General information

NPI: 1962011734
Provider Name (Legal Business Name): CESCA MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2020
Last Update Date: 06/10/2021
Certification Date: 06/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15424 HAWTHORNE BLVD STE 302
LAWNDALE CA
90260-2175
US

IV. Provider business mailing address

15424 HAWTHORNE BLVD STE 302
LAWNDALE CA
90260-2175
US

V. Phone/Fax

Practice location:
  • Phone: 424-310-2707
  • Fax:
Mailing address:
  • Phone: 424-310-2707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. FRANCESCA CHINWE MEPHORS
Title or Position: C.E.O
Credential:
Phone: 424-200-3333