Healthcare Provider Details

I. General information

NPI: 1710688155
Provider Name (Legal Business Name): GRIEAY LASHON THOMPSON MPSS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2023
Last Update Date: 01/10/2024
Certification Date: 01/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6317 S FIGUEROA ST
LOS ANGELES CA
90003-1025
US

IV. Provider business mailing address

PO BOX 561323
LOS ANGELES CA
90056-0207
US

V. Phone/Fax

Practice location:
  • Phone: 323-301-8120
  • Fax: 323-544-0890
Mailing address:
  • Phone: 323-306-8120
  • Fax: 323-544-0890

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 Code175T00000X
TaxonomyPeer Specialist
License NumberMPSS-SDKJCW
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: