Healthcare Provider Details

I. General information

NPI: 1366154452
Provider Name (Legal Business Name): DR. DAYANARA AMIRA THOMPSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2022
Last Update Date: 12/20/2022
Certification Date: 12/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19000 HAWTHORNE BLVD STE 302
TORRANCE CA
90503-1517
US

IV. Provider business mailing address

5550 HOLLYWOOD BLVD
LOS ANGELES CA
90028-7369
US

V. Phone/Fax

Practice location:
  • Phone: 310-793-9400
  • Fax:
Mailing address:
  • Phone: 415-792-9338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License Number36504
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: