Healthcare Provider Details

I. General information

NPI: 1659792224
Provider Name (Legal Business Name): USC TELEHEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2013
Last Update Date: 12/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3375 S HOOVER ST STE H201
LOS ANGELES CA
90089-2858
US

IV. Provider business mailing address

510 SHELLY RIDGE LN APT 105
RALEIGH NC
27609-2858
US

V. Phone/Fax

Practice location:
  • Phone: 866-740-6502
  • Fax:
Mailing address:
  • Phone: 910-635-6247
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. NADIA ISLAM
Title or Position: CLINICAL DIRECTOR
Credential:
Phone: 866-740-6502