Healthcare Provider Details

I. General information

NPI: 1225964323
Provider Name (Legal Business Name): THRIVE LA MEDICAL CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4221 S ALAMEDA ST
VERNON CA
90058-1601
US

IV. Provider business mailing address

4221 S ALAMEDA ST
VERNON CA
90058-1601
US

V. Phone/Fax

Practice location:
  • Phone: 213-515-9069
  • Fax:
Mailing address:
  • Phone: 213-515-9069
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: BROWNELL H PAYNE
Title or Position: CEO/OWNER
Credential: MD
Phone: 213-515-9069