Healthcare Provider Details

I. General information

NPI: 1013832476
Provider Name (Legal Business Name): ELIMSOL MENTAL HEALTH, A NURSING P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

903 CRENSHAW BLVD STE 304
LOS ANGELES CA
90019-1967
US

IV. Provider business mailing address

903 CRENSHAW BLVD STE 304
LOS ANGELES CA
90019-1967
US

V. Phone/Fax

Practice location:
  • Phone: 424-433-3389
  • Fax: 424-550-3267
Mailing address:
  • Phone: 424-433-3389
  • Fax: 424-550-3267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: SALLY PARK
Title or Position: OWNER
Credential: NP
Phone: 424-433-3389