Healthcare Provider Details

I. General information

NPI: 1134740749
Provider Name (Legal Business Name): TIZITA WORKU SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2020
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 S BEAUDRY AVE
LOS ANGELES CA
90017-1466
US

IV. Provider business mailing address

1737 E WOODGATE DR
WEST COVINA CA
91792-1949
US

V. Phone/Fax

Practice location:
  • Phone: 213-241-6225
  • Fax:
Mailing address:
  • Phone: 757-285-3569
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSPA3378
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: