Healthcare Provider Details

I. General information

NPI: 1154821585
Provider Name (Legal Business Name): GINA TUVALU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2018
Last Update Date: 04/24/2024
Certification Date: 04/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 S WESTLAKE AVE
LOS ANGELES CA
90057-2906
US

IV. Provider business mailing address

360 S WESTLAKE AVE
LOS ANGELES CA
90057-2906
US

V. Phone/Fax

Practice location:
  • Phone: 213-483-9201
  • Fax: 213-382-0136
Mailing address:
  • Phone: 213-483-9201
  • Fax: 626-246-3433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: