Healthcare Provider Details

I. General information

NPI: 1215342803
Provider Name (Legal Business Name): COMPASSION FOR TEEN LIFE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2014
Last Update Date: 06/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 E FLORENCE AVE
LOS ANGELES CA
90001-2432
US

IV. Provider business mailing address

1201 E FLORENCE AVE
LOS ANGELES CA
90001-2432
US

V. Phone/Fax

Practice location:
  • Phone: 323-588-0084
  • Fax:
Mailing address:
  • Phone: 323-588-0084
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. LORNA MAE JOHNSON
Title or Position: ADMINISTRATOR
Credential: MSN, NP, CNM
Phone: 323-588-0084