Provider Demographics
NPI:1013454511
Name:PRINCE, JOAN
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:
Last Name:PRINCE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 W QUEEN ST APT 2
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90301-1071
Mailing Address - Country:US
Mailing Address - Phone:310-910-4812
Mailing Address - Fax:310-602-6272
Practice Address - Street 1:540 W QUEEN ST APT 2
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-1071
Practice Address - Country:US
Practice Address - Phone:310-910-4812
Practice Address - Fax:310-602-6272
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-23
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator