Healthcare Provider Details

I. General information

NPI: 1306646526
Provider Name (Legal Business Name): AUDACITY GLOBAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2025
Last Update Date: 10/13/2025
Certification Date: 10/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8928 S FIGUEROA ST
LOS ANGELES CA
90003-3228
US

IV. Provider business mailing address

3025 ARTESIA BLVD # 75
TORRANCE CA
90504-2600
US

V. Phone/Fax

Practice location:
  • Phone: 213-537-3881
  • Fax:
Mailing address:
  • Phone: 213-537-3881
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. NYREE BERRY
Title or Position: CEO
Credential:
Phone: 213-537-3881