Healthcare Provider Details

I. General information

NPI: 1790603603
Provider Name (Legal Business Name): CALIFORNIA CREATIVE LEARNING ACADEMY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2709 MEDIA CENTER DR
LOS ANGELES CA
90065-1700
US

IV. Provider business mailing address

2709 MEDIA CENTER DR
LOS ANGELES CA
90065-1700
US

V. Phone/Fax

Practice location:
  • Phone: 323-539-2810
  • Fax:
Mailing address:
  • Phone: 323-539-2810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State

VIII. Authorized Official

Name: LINDA LEE
Title or Position: EXECUTIVE DIRECTOR / PRINCIPAL
Credential:
Phone: 323-539-2810