Healthcare Provider Details

I. General information

NPI: 1851710883
Provider Name (Legal Business Name): USC TELEHEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2014
Last Update Date: 04/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3375 S HOOVER ST
LOS ANGELES CA
90089-0116
US

IV. Provider business mailing address

3375 S HOOVER ST
LOS ANGELES CA
90089-0116
US

V. Phone/Fax

Practice location:
  • Phone: 213-821-5977
  • Fax:
Mailing address:
  • Phone: 213-821-5977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. ALLEN LEE PLANGKLANG
Title or Position: INTERN/MENTAL HEALTH COUNSELOR
Credential:
Phone: 213-821-5977