Healthcare Provider Details

I. General information

NPI: 1942916333
Provider Name (Legal Business Name): PROGRAM FOR TORTURE VICTIMS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2023
Last Update Date: 01/14/2025
Certification Date: 01/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 W 6TH ST STE 450
LOS ANGELES CA
90017-2708
US

IV. Provider business mailing address

800 W 6TH ST STE 450
LOS ANGELES CA
90017-2708
US

V. Phone/Fax

Practice location:
  • Phone: 213-384-4788
  • Fax:
Mailing address:
  • Phone: 213-384-4788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: ANA GRANDE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 213-384-4788