Healthcare Provider Details

I. General information

NPI: 1255815155
Provider Name (Legal Business Name): MARY ALICE SWINEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2018
Last Update Date: 09/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3437 STOCKER ST APT 4
LOS ANGELES CA
90008-3730
US

IV. Provider business mailing address

3437 STOCKER ST APT 4
LOS ANGELES CA
90008-3730
US

V. Phone/Fax

Practice location:
  • Phone: 323-377-5177
  • Fax:
Mailing address:
  • Phone: 323-377-5177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: