Healthcare Provider Details

I. General information

NPI: 1932439767
Provider Name (Legal Business Name): TERRANCE ROGER ITO FNP-BC, PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2009
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13323 W WASHINGTON BLVD STE 202
LOS ANGELES CA
90066-5163
US

IV. Provider business mailing address

PO BOX 31309
LOS ANGELES CA
90031-0309
US

V. Phone/Fax

Practice location:
  • Phone: 213-762-0690
  • Fax: 213-762-0732
Mailing address:
  • Phone: 818-790-7100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number19434
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP19434
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number556344
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: