Healthcare Provider Details

I. General information

NPI: 1407723471
Provider Name (Legal Business Name):
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2025
Last Update Date: 10/22/2025
Certification Date: 10/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4876 GLEASON ST
LOS ANGELES CA
90022-1680
US

IV. Provider business mailing address

222 N VIRGIL AVE
LOS ANGELES CA
90004-3622
US

V. Phone/Fax

Practice location:
  • Phone: 213-480-4200
  • Fax:
Mailing address:
  • Phone: 212-480-4200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number StateNULL

VIII. Authorized Official

Name: NATHAN ARIAS
Title or Position: PRESIDENT/CEO
Credential:
Phone: 213-480-4200