Healthcare Provider Details

I. General information

NPI: 1417757725
Provider Name (Legal Business Name): HEALTH INTEGRATED, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2025
Last Update Date: 03/17/2025
Certification Date: 03/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 E 111TH ST
LOS ANGELES CA
90061-3003
US

IV. Provider business mailing address

PO BOX 213093
CHULA VISTA CA
91921-3093
US

V. Phone/Fax

Practice location:
  • Phone: 888-417-5163
  • Fax: 888-316-1604
Mailing address:
  • Phone: 888-417-5163
  • Fax: 888-316-1604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: DWAYNE THOMPSON
Title or Position: BUSINESS ADMINISTRATOR
Credential: LVN, BA, CNA
Phone: 714-278-7622