Healthcare Provider Details

I. General information

NPI: 1609796325
Provider Name (Legal Business Name): LOS ANGELES ACADEMY OF ARTS AND ENTERPRISE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1575 W 2ND ST RM 477
LOS ANGELES CA
90026-5701
US

IV. Provider business mailing address

1575 W 2ND ST RM 477
LOS ANGELES CA
90026-5701
US

V. Phone/Fax

Practice location:
  • Phone: 213-487-0600
  • Fax: 213-487-0500
Mailing address:
  • Phone: 213-487-0600
  • Fax: 213-487-0500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State

VIII. Authorized Official

Name: ALEJANDRO MACIAS
Title or Position: EXECUTIVE DIRECTOR
Credential: PPS
Phone: 213-487-0600