Healthcare Provider Details

I. General information

NPI: 1356758080
Provider Name (Legal Business Name): AMINAH CHERRY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2014
Last Update Date: 06/28/2023
Certification Date: 10/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

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

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberCA130477
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberA130477
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA130477
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: