Healthcare Provider Details

I. General information

NPI: 1952031908
Provider Name (Legal Business Name): LITTLEDOVE F REY MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2022
Last Update Date: 06/13/2022
Certification Date: 06/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 WESTWOOD PLAZA
LOS ANGELES CA
90095-0001
US

IV. Provider business mailing address

1555 SAN YSIDRO DR
BEVERLY HILLS CA
90210-2110
US

V. Phone/Fax

Practice location:
  • Phone: 310-825-0768
  • Fax:
Mailing address:
  • Phone: 916-955-8480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: