MEDICARE: TERRANCE ROGER ITO FNP-BC, PMHNP-BC

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	19434	CA
2	363LF0000X	Family Nurse Practitioner	NP19434	CA
3	163W00000X	Registered Nurse	556344	CA

General Provider Information

NPI Number	:	1932439767
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERRANCE ROGER ITO FNP-BC, PMHNP-BC

Provider Business Mailing Address
First Line	:	PO BOX 31309
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90031-0309
Country	:	US
Telephone Number	:	818-790-7100
Fax Number	:

Provider Business Practice Location Address
First Line	:	13323 W WASHINGTON BLVD STE 202
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90066-5163
Country	:	US
Telephone Number	:	213-762-0690
Fax Number	:	213-762-0732

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/29/2009
Last Update Date	:	04/23/2026

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