Healthcare Provider Details

I. General information

NPI: 1487898664
Provider Name (Legal Business Name): INSTITUTE FOR MAXIMUM HUMAN POTENTIAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2009
Last Update Date: 03/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9624 COMPTON AVE
LOS ANGELES CA
90002-2333
US

IV. Provider business mailing address

PO BOX 72059
LOS ANGELES CA
90002-0059
US

V. Phone/Fax

Practice location:
  • Phone: 323-567-9883
  • Fax: 323-567-9885
Mailing address:
  • Phone: 323-567-9883
  • Fax: 323-567-9885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. DELORES BROWN
Title or Position: PRESIDENT
Credential:
Phone: 323-567-9883