Healthcare Provider Details

I. General information

NPI: 1508759366
Provider Name (Legal Business Name): A LIGHTENED PATH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2025
Last Update Date: 05/30/2025
Certification Date: 05/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3310 W VERNON AVE
LOS ANGELES CA
90008-5230
US

IV. Provider business mailing address

3310 W VERNON AVE
LOS ANGELES CA
90008-5230
US

V. Phone/Fax

Practice location:
  • Phone: 323-399-2595
  • Fax:
Mailing address:
  • Phone: 323-399-2595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code177F00000X
TaxonomyLodging Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. NINA TATIANA GRAY
Title or Position: CEO
Credential: M.A.
Phone: 323-399-2595