Healthcare Provider Details

I. General information

NPI: 1528464682
Provider Name (Legal Business Name): MS. TYLANA LASHELLE THOMAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2014
Last Update Date: 06/05/2023
Certification Date: 06/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 S VERMONT AVE
LOS ANGELES CA
90020-1912
US

IV. Provider business mailing address

2523 W 7TH ST
LOS ANGELES CA
90057-3801
US

V. Phone/Fax

Practice location:
  • Phone: 213-514-0414
  • Fax: 213-947-4579
Mailing address:
  • Phone: 626-227-7014
  • Fax: 213-480-1557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: