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General NPI Number Information
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NPI Number | 1689465718
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Entity Type | Organization
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Legal Business Name | LIBERTAS COLLEGE PREPARATORY
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Dates
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Enumeration Date | 05/16/2025
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Last Update Date | 05/16/2025
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Provider Practice Location Address
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Address Line | 5101 S WESTERN AVE
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City | LOS ANGELES
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State | CA
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Zip | 90062-2333
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Country | US
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Telephone | 323-400-6149
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Fax |
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Provider Business Mailing Address
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Address Line | 5101 S WESTERN AVE
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City | LOS ANGELES
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State | CA
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Zip | 90062-2333
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Country | US
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Telephone | 323-400-6149
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF LEADERSHIP DEVELOPMENT
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Name | ANNA CARLSTONE HURST
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Credential |
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Telephone | 310-902-6808
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251300000X
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Taxonomy Name | Local Education Agency (LEA)
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License Number |
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License Number State |
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