Healthcare Provider Details

I. General information

NPI: 1083494124
Provider Name (Legal Business Name): LASHUN ANQUENETTA SPRAGG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2023
Last Update Date: 05/28/2025
Certification Date: 05/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

631 MAPLE AVE
LOS ANGELES CA
90014-2211
US

IV. Provider business mailing address

244 E ARTESIA BLVD
LONG BEACH CA
90805-1214
US

V. Phone/Fax

Practice location:
  • Phone: 213-673-3027
  • Fax:
Mailing address:
  • Phone: 562-972-5181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: