Healthcare Provider Details

I. General information

NPI: 1184931347
Provider Name (Legal Business Name): HOUSE HEALTHCARE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2010
Last Update Date: 09/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 W 3RD ST SUITE 111
LOS ANGELES CA
90057-1944
US

IV. Provider business mailing address

PO BOX 74070
LOS ANGELES CA
90004-0070
US

V. Phone/Fax

Practice location:
  • Phone: 213-483-9930
  • Fax: 213-483-0905
Mailing address:
  • Phone: 213-483-9930
  • Fax: 213-483-0905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207YX0602X
TaxonomyOtolaryngic Allergy Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. MARY JENNIFER DEREBERY
Title or Position: VICE PRESIDENT
Credential: M.D.
Phone: 213-483-9930