Healthcare Provider Details

I. General information

NPI: 1962834267
Provider Name (Legal Business Name): USC TELEHEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2013
Last Update Date: 08/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3375 S HOOVER ST STE H201
LOS ANGELES CA
90089-0116
US

IV. Provider business mailing address

3375 S HOOVER ST STE H201
LOS ANGELES CA
90089-0116
US

V. Phone/Fax

Practice location:
  • Phone: 866-740-6502
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name: NADIA ISLAM
Title or Position: CLINICAL DIRECTOR
Credential:
Phone: 866-740-6502