Healthcare Provider Details

I. General information

NPI: 1902904824
Provider Name (Legal Business Name): LA SHONDA YVETTE SPENCER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1640 MARENGO ST HRA 300
LOS ANGELES CA
90033-1036
US

IV. Provider business mailing address

6430 W SUNSET BLVD SUITE 600
LOS ANGELES CA
90028-7901
US

V. Phone/Fax

Practice location:
  • Phone: 323-226-5068
  • Fax: 323-226-2505
Mailing address:
  • Phone: 323-669-2337
  • Fax: 323-644-8488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License NumberA76338
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: