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General NPI Number Information
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NPI Number | 1740154392
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Entity Type | Organization
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Legal Business Name | HAVEN HEALTH GROUP LOS ANGELES PC
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Dates
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Enumeration Date | 10/06/2025
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Last Update Date | 10/06/2025
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Provider Practice Location Address
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Address Line | 6221 WILSHIRE BLVD STE 216
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City | LOS ANGELES
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State | CA
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Zip | 90048-5226
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Country | US
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Telephone | 213-415-2214
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Fax | 213-816-6334
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Provider Business Mailing Address
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Address Line | 6221 WILSHIRE BLVD STE 216
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City | LOS ANGELES
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State | CA
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Zip | 90048-5226
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Country | US
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Telephone | 213-415-2214
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Fax | 213-816-6334
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Authorized Official
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Title or Position | CEO
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Name | MIKE PISCADLO
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Credential |
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Telephone | 213-415-2214
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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