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General NPI Number Information
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NPI Number | 1720880941
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Entity Type | Organization
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Legal Business Name | TUNGSTEN HEALTH SOUTH LOS ANGELES
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Dates
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Enumeration Date | 03/26/2025
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Last Update Date | 03/26/2025
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Provider Practice Location Address
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Address Line | 1005 E ROSECRANS AVE
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City | EAST RANCHO DOMINGUEZ
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State | CA
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Zip | 90221-2149
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Country | US
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Telephone | 508-212-9951
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Fax |
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Provider Business Mailing Address
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Address Line | 39 ARKANSAS ST
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City | SAN FRANCISCO
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State | CA
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Zip | 94107-2434
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Country | US
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Telephone | 508-212-9951
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Fax |
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Authorized Official
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Title or Position | MANAGER, NEW MARKETS
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Name | VICTORIA CLEVELAND
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Credential |
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Telephone | 508-212-9951
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251T00000X
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Taxonomy Name | PACE Provider Organization
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License Number |
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License Number State |
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