Healthcare Provider Details

I. General information

NPI: 1558789578
Provider Name (Legal Business Name): BRUCE FOSTER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2014
Last Update Date: 03/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 ST PAUL AVE SUITE 200
LOS ANGELES CA
90017-2038
US

IV. Provider business mailing address

600 ST PAUL AVE SUITE 200
LOS ANGELES CA
90017-2038
US

V. Phone/Fax

Practice location:
  • Phone: 213-482-6400
  • Fax:
Mailing address:
  • Phone: 213-482-6400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: