Healthcare Provider Details

I. General information

NPI: 1447270988
Provider Name (Legal Business Name): ELIZABETH JEAN COVINGTON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 06/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3701 STOCKER ST STE 101
LOS ANGELES CA
90008-5145
US

IV. Provider business mailing address

3701 STOCKER ST STE 101
LOS ANGELES CA
90008-5145
US

V. Phone/Fax

Practice location:
  • Phone: 323-290-2107
  • Fax:
Mailing address:
  • Phone: 323-290-2107
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG40179
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: