MEDICARE: LITTLE SLOTH HEALTHCARE, P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0804X	Child & Adolescent Psychiatry Physician
2	261QM0855X	Adolescent and Children Mental Health Clinic/Center

General Provider Information

NPI Number	:	1033785274
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LITTLE SLOTH HEALTHCARE, P.C.

Provider Business Mailing Address
First Line	:	660 4TH ST STE 168
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94107-1618
Country	:	US
Telephone Number	:	415-449-2813
Fax Number	:

Provider Business Practice Location Address
First Line	:	515 S FLOWER ST OFC 1815
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90071-2201
Country	:	US
Telephone Number	:	415-449-2813
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	OLUWAFIKUNMI SOBOWALE
Credential	:	MD
Telephone Number	:	631-627-4877

Provider Enumeration Date	:	05/28/2021
Last Update Date	:	08/23/2024

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