Healthcare Provider Details

I. General information

NPI: 1013834399
Provider Name (Legal Business Name): SHENEICE EMBRAY LPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 W 83RD ST
LOS ANGELES CA
90044-3403
US

IV. Provider business mailing address

1125 W 83RD ST
LOS ANGELES CA
90044-3403
US

V. Phone/Fax

Practice location:
  • Phone: 424-426-9217
  • Fax:
Mailing address:
  • Phone: 424-426-9217
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code167G00000X
TaxonomyLicensed Psychiatric Technician
License Number43268
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: