Healthcare Provider Details

I. General information

NPI: 1184851545
Provider Name (Legal Business Name): KEVIN FOSTER PA/NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2009
Last Update Date: 05/02/2024
Certification Date: 05/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1240 N MISSION RD
LOS ANGELES CA
90033-1019
US

IV. Provider business mailing address

1240 N MISSION RD
LOS ANGELES CA
90033-1019
US

V. Phone/Fax

Practice location:
  • Phone: 323-409-3750
  • Fax:
Mailing address:
  • Phone: 323-409-3750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA 14057
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number487853
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: