Healthcare Provider Details

I. General information

NPI: 1093959058
Provider Name (Legal Business Name): TRANSITION TO HEALTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2009
Last Update Date: 04/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

532 N VISTA ST
LOS ANGELES CA
90036-5743
US

IV. Provider business mailing address

532 N VISTA ST
LOS ANGELES CA
90036-5743
US

V. Phone/Fax

Practice location:
  • Phone: 323-876-3600
  • Fax:
Mailing address:
  • Phone: 323-876-3600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number3027187
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number3027187
License Number StateCA

VIII. Authorized Official

Name: DR. MATTHEW A LEDERMAN
Title or Position: PRESIDENT
Credential: MD
Phone: 323-876-3600