1053861328 NPI number — PEOPLE COORDINATED SERVICES OF SOUTHERN CALIFORNIA, INC.

Table of content: MS. PRISCILLA GAIL HOOPER CRNP (NPI 1245268135)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053861328 NPI number — PEOPLE COORDINATED SERVICES OF SOUTHERN CALIFORNIA, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PEOPLE COORDINATED SERVICES OF SOUTHERN CALIFORNIA, INC.
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:
6
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:
1053861328
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/10/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1221 S WESTERN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90006-3107
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
323-735-1231
Provider Business Mailing Address Fax Number:
323-735-7059

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3021 S VERMONT 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:
90007-3033
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-732-9124
Provider Business Practice Location Address Fax Number:
323-735-7059
Provider Enumeration Date:
10/10/2016

Additional Information

Authorized Official

Authorized Official Last Name:
WALKER
Authorized Official First Name:
VIRGIE
Authorized Official Middle Name:
PRICE
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
323-735-1231

Provider Taxonomy Codes

  • Taxonomy code: 261QR0405X , with the licence number:  190013BN , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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