Healthcare Provider Details

I. General information

NPI: 1932035771
Provider Name (Legal Business Name): SUSTAINABLE ECONOMIC ENTERPRISES OF LOS ANGELES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2026
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1231 N SPRING ST STE C-102
LOS ANGELES CA
90012-1838
US

IV. Provider business mailing address

1231 N SPRING ST STE C-102
LOS ANGELES CA
90012-1838
US

V. Phone/Fax

Practice location:
  • Phone: 817-845-5793
  • Fax:
Mailing address:
  • Phone: 817-845-5793
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335G00000X
TaxonomyMedical Foods Supplier
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER GRISSOM
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 817-845-5793