1689403164 NPI number — MINDFUL GROWTH FOUNDATION

Table of content: SHEILA CAGARA SAYONG OTA (NPI 1801917745)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689403164 NPI number — MINDFUL GROWTH FOUNDATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MINDFUL GROWTH FOUNDATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1689403164
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/08/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4900 ANGELES VISTA BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VIEW PARK
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90043-1737
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
323-590-9813
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6430 3RD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90043-4542
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-590-9813
Provider Business Practice Location Address Fax Number:
323-983-4212
Provider Enumeration Date:
07/31/2024

Additional Information

Authorized Official

Authorized Official Last Name:
SAMPSON
Authorized Official First Name:
JASMINE
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
323-590-9813

Provider Taxonomy Codes

  • Taxonomy code: 320800000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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