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Organization
FOUNTAIN OF LIFE CENTRE
Active
Organization
FOUNTAIN OF LIFE CENTRE
Active
Other names
North End Spinal Treatment
Organization subpart
No
Provider details
NPI number
Authorized official
LINDA S TWETEN PAR,CCS PATIENT ACCO (GENERAL MANAGER)
(310) 940-1259
Entity
Organization
Contact information
Practice address
350 W 5TH STREET, SUITE 105 1/2, SAN PEDRO, CA 90731-2751
(310) 940-1259
(424) 477-5398
Mailing address
4733 TORRANCE BLVD, PMB #464, TORRANCE, CA 90503-4100
(310) 940-1259
(424) 477-5398
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
193200000X
CA
Other
Enumeration date
09/13/2016
Last updated
04/28/2026
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