Healthcare Provider Details

I. General information

NPI: 1932583564
Provider Name (Legal Business Name): RENAISSANCE SOUTH LA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2015
Last Update Date: 07/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19401 SOUTH VERMONT AVENUE, SUITE C100
TORRANCE CA
90502-1029
US

IV. Provider business mailing address

19401 SOUTH VERMONT AVENUE, SUITE C100
TORRANCE CA
90502-1029
US

V. Phone/Fax

Practice location:
  • Phone: 213-545-6353
  • Fax:
Mailing address:
  • Phone: 213-545-6353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number
License Number State

VIII. Authorized Official

Name: MRS. LYRIC ARMSTRONG
Title or Position: CEO
Credential:
Phone: 213-545-6353