Healthcare Provider Details

I. General information

NPI: 1265466189
Provider Name (Legal Business Name): LITTLE COMPANY OF MARY ANCILLARY SERVICES CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 05/09/2025
Certification Date: 05/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5215 TORRANCE BLVD STE 110
TORRANCE CA
90503-4009
US

IV. Provider business mailing address

PO BOX 31001-3017
PASADENA CA
91110-3017
US

V. Phone/Fax

Practice location:
  • Phone: 310-316-2424
  • Fax: 310-540-0374
Mailing address:
  • Phone: 310-316-2424
  • Fax: 310-540-0374

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0206X
TaxonomyMammography Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DONALD W ANDERSON JR.
Title or Position: ASSISTANT SECRETARY ENROLLMENTS
Credential:
Phone: 425-358-9786