Healthcare Provider Details

I. General information

NPI: 1033785274
Provider Name (Legal Business Name): LITTLE SLOTH HEALTHCARE, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2021
Last Update Date: 08/23/2024
Certification Date: 08/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 S FLOWER ST OFC 1815
LOS ANGELES CA
90071-2201
US

IV. Provider business mailing address

660 4TH ST STE 168
SAN FRANCISCO CA
94107-1618
US

V. Phone/Fax

Practice location:
  • Phone: 415-449-2813
  • Fax:
Mailing address:
  • Phone: 415-449-2813
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: OLUWAFIKUNMI SOBOWALE
Title or Position: DIRECTOR
Credential: MD
Phone: 631-627-4877