Healthcare Provider Details

I. General information

NPI: 1376721639
Provider Name (Legal Business Name): AMICUS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2008
Last Update Date: 01/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

645 N GARDNER ST
LOS ANGELES CA
90036-5712
US

IV. Provider business mailing address

PO BOX 480179
LOS ANGELES CA
90048-1179
US

V. Phone/Fax

Practice location:
  • Phone: 323-683-8321
  • Fax: 651-400-5476
Mailing address:
  • Phone: 323-683-8321
  • Fax: 651-400-5476

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. PAULETTE R. CASWELL
Title or Position: CEO
Credential: PH.D.
Phone: 323-683-8321