Healthcare Provider Details

I. General information

NPI: 1942031562
Provider Name (Legal Business Name): STARR LYNETTE FOX PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2024
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

626 WILSHIRE BLVD
LOS ANGELES CA
90017-3209
US

IV. Provider business mailing address

626 WILSHIRE BLVD STE 410
LOS ANGELES CA
90017-2915
US

V. Phone/Fax

Practice location:
  • Phone: 323-996-2996
  • Fax: 323-319-3255
Mailing address:
  • Phone: 323-996-2996
  • Fax: 323-319-3255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95031651
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: