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NPI Code Detail

MEDICARE: SYVRANT GENISYS EXXODUS TRAN LPT

MEDICARE: SYVRANT GENISYS EXXODUS TRAN LPT
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
1167G00000XLicensed Psychiatric Technician37590CA

General Provider Information

NPI Number : 1578455051
Entity Type Code : Individual
Provider Name (Legal Business Name) : SYVRANT GENISYS EXXODUS TRAN LPT
Provider Business Mailing Address
First Line : 840 N AVENUE 66
Second Line :
City : LOS ANGELES
State : CA
Zip : 90042-1508
Country : US
Telephone Number : 626-395-7100
Fax Number :
Provider Business Practice Location Address
First Line : 840 N AVENUE 66
Second Line :
City : LOS ANGELES
State : CA
Zip : 90042-1508
Country : US
Telephone Number : 626-395-7100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/17/2025
Last Update Date : 06/10/2026

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