Healthcare Provider Details

I. General information

NPI: 1649581547
Provider Name (Legal Business Name): MRS. SHARECA LASHAWN SWAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2010
Last Update Date: 11/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1233 S LA CIENEGA BLVD
LOS ANGELES CA
90035-2520
US

IV. Provider business mailing address

4760 SEPULVEDA BLVD
LOS ANGELES CA
90230-4820
US

V. Phone/Fax

Practice location:
  • Phone: 310-855-0031
  • Fax: 310-855-0138
Mailing address:
  • Phone: 310-390-6612
  • Fax: 310-398-5690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: