Healthcare Provider Details

I. General information

NPI: 1659295343
Provider Name (Legal Business Name): BRIGHT SOURCE HOSPICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 N LA BREA AVE STE 556
WEST HOLLYWOOD CA
90038-2458
US

IV. Provider business mailing address

925 N LA BREA AVE STE 556
WEST HOLLYWOOD CA
90038-2458
US

V. Phone/Fax

Practice location:
  • Phone: 310-383-7760
  • Fax: 310-405-0808
Mailing address:
  • Phone: 310-383-7760
  • Fax: 310-405-0808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: QUERUBIN IGNACIO
Title or Position: CEO
Credential:
Phone: 310-383-7760