Healthcare Provider Details

I. General information

NPI: 1417310962
Provider Name (Legal Business Name): LUISA F. M. TEMPLE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2016
Last Update Date: 01/13/2022
Certification Date: 01/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HOWARD UNIVERSITY HOSPITAL 2041 GEORGIA AVE NW
WASHINGTON DC
20060-0001
US

IV. Provider business mailing address

4501 SAND CREEK RD
ANTIOCH CA
94531-8687
US

V. Phone/Fax

Practice location:
  • Phone: 202-865-1161
  • Fax: 202-865-4174
Mailing address:
  • Phone: 202-865-1161
  • Fax: 202-865-4174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License NumberA168868
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: