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Organization
SOUL STREET MEDICINE, INC.
Active
Organization
SOUL STREET MEDICINE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROMAN ROZHANSKY (PRESIDENT)
(855) 669-1900
Entity
Organization
Contact information
Practice address
801 W 70TH ST, LOS ANGELES, CA 90044-5218
(855) 669-1900
(323) 983-4323
Mailing address
145 S FAIRFAX AVE STE 200, LOS ANGELES, CA 90036-2186
(855) 669-1900
(323) 983-4323
Taxonomy
Speciality
Code
Description
License number
State
363LC1500X
Community Health Nurse Practitioner
—
NULL
363LC1500X
Community Health Nurse Practitioner
—
—
385H00000X
Respite Care
Primary
—
NULL
Other
Enumeration date
07/22/2024
Last updated
07/22/2024
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