Healthcare Provider Details

I. General information

NPI: 1215229505
Provider Name (Legal Business Name): MR. ASHON GLOVER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2011
Last Update Date: 05/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

529 MAPLE AVE
LOS ANGELES CA
90013-1511
US

IV. Provider business mailing address

529 MAPLE AVE
LOS ANGELES CA
90013-1511
US

V. Phone/Fax

Practice location:
  • Phone: 213-430-6700
  • Fax:
Mailing address:
  • Phone: 213-430-6700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number653279
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: