Healthcare Provider Details

I. General information

NPI: 1962928150
Provider Name (Legal Business Name): EMILY PRISCILLA SOUSA PHD, PPCNP-BC, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2017
Last Update Date: 02/08/2023
Certification Date: 02/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4650 W SUNSET BLVD # MS 61
LOS ANGELES CA
90027-6062
US

IV. Provider business mailing address

4650 W SUNSET BLVD # MS 61
LOS ANGELES CA
90027-6062
US

V. Phone/Fax

Practice location:
  • Phone: 323-361-4606
  • Fax: 323-361-1301
Mailing address:
  • Phone: 323-361-4606
  • Fax: 323-361-1301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number95007747
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number129110
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95133798
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: