Healthcare Provider Details

I. General information

NPI: 1447671334
Provider Name (Legal Business Name): USC-TELEHEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2013
Last Update Date: 12/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

17202 INGLEWOOD AVE UNIT 122
LAWNDALE CA
90260-3139
US

V. Phone/Fax

Practice location:
  • Phone: 213-821-5930
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: KRYSTAL BOWEN
Title or Position: CLINICAL PSYCHOTHERAPIST, INTERN
Credential:
Phone: 310-256-6488