Healthcare Provider Details

I. General information

NPI: 1275455024
Provider Name (Legal Business Name): RISEN HEALTH PARTNERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1216 N FORMOSA AVE APT 1
WEST HOLLYWOOD CA
90046-5895
US

IV. Provider business mailing address

925 N LA BREA AVE STE 500 PMB 504
LOS ANGELES CA
90038-2458
US

V. Phone/Fax

Practice location:
  • Phone: 323-405-7725
  • Fax: 323-405-7735
Mailing address:
  • Phone: 323-405-7725
  • Fax: 323-405-7735

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State

VIII. Authorized Official

Name: EKATERINA TIMOFEEVA
Title or Position: PRESIDENT
Credential: PHD
Phone: 323-405-7725