Healthcare Provider Details

I. General information

NPI: 1679658041
Provider Name (Legal Business Name): TRACEY LEE NORTON D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 03/22/2021
Certification Date: 03/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 S GRAND AVE STE 101
LOS ANGELES CA
90015-3048
US

IV. Provider business mailing address

1400 S GRAND AVE STE 101
LOS ANGELES CA
90015-3048
US

V. Phone/Fax

Practice location:
  • Phone: 213-744-0801
  • Fax: 213-741-1423
Mailing address:
  • Phone: 213-744-0801
  • Fax: 213-741-1423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0000X
TaxonomyAdolescent Medicine (Family Medicine) Physician
License Number20A4911
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: