Healthcare Provider Details

I. General information

NPI: 1063002004
Provider Name (Legal Business Name): UNITE A NATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2021
Last Update Date: 01/23/2021
Certification Date: 01/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6755 6TH AVE
LOS ANGELES CA
90043-4407
US

IV. Provider business mailing address

6755 6TH AVE
LOS ANGELES CA
90043-4407
US

V. Phone/Fax

Practice location:
  • Phone: 323-403-8112
  • Fax:
Mailing address:
  • Phone: 323-403-8112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code177F00000X
TaxonomyLodging Provider
License Number
License Number State

VIII. Authorized Official

Name: DANIELLE LAFAYETTE
Title or Position: EXECUTIVE DIRECTOR
Credential: DO
Phone: 323-403-8112