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General NPI Number Information
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NPI Number | 1215342803
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Entity Type | Organization
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Legal Business Name | COMPASSION FOR TEEN LIFE, INC.
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Dates
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Enumeration Date | 06/23/2014
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Last Update Date | 06/23/2014
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Provider Practice Location Address
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Address Line | 1201 E FLORENCE AVE
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City | LOS ANGELES
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State | CA
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Zip | 90001-2432
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Country | US
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Telephone | 323-588-0084
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Fax |
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Provider Business Mailing Address
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Address Line | 1201 E FLORENCE AVE
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City | LOS ANGELES
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State | CA
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Zip | 90001-2432
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Country | US
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Telephone | 323-588-0084
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. LORNA MAE JOHNSON
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Credential | MSN, NP, CNM
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Telephone | 323-588-0084
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State |
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