Healthcare Provider Details

I. General information

NPI: 1184268302
Provider Name (Legal Business Name): LSA EXCLUSIVE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2019
Last Update Date: 10/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6320 CANOGA AVE STE 1500
WOODLAND HILLS CA
91367-2517
US

IV. Provider business mailing address

18948 LASSEN ST
NORTHRIDGE CA
91324-1835
US

V. Phone/Fax

Practice location:
  • Phone: 323-423-0054
  • Fax:
Mailing address:
  • Phone: 323-423-0054
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: SHABANA AZMI JAMEEL AHAMED
Title or Position: MANAGING MEMBER
Credential:
Phone: 323-423-0054