Healthcare Provider Details

I. General information

NPI: 1942441266
Provider Name (Legal Business Name): MS. FORTUNATE HOVE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2009
Last Update Date: 03/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19231 VICTORY BLVD 554
RESEDA CA
91335-6308
US

IV. Provider business mailing address

15477 EL CAJON ST.
SYLMAR CA
91342
US

V. Phone/Fax

Practice location:
  • Phone: 818-776-1755
  • Fax:
Mailing address:
  • Phone: 818-367-1697
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: