# SOUL STREET MEDICINE, INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1114755139
- **Authorized official:** ROMAN ROZHANSKY (PRESIDENT)
- **Authorized official phone:** (855) 669-1900

## Contact information

- **Practice address:** 801 W 70TH ST, LOS ANGELES, CA 90044-5218
- **Practice address phone:** (855) 669-1900
- **Practice address fax:** (323) 983-4323
- **Mailing address:** 145 S FAIRFAX AVE STE 200, LOS ANGELES, CA 90036-2186
- **Mailing address phone:** (855) 669-1900
- **Mailing address fax:** (323) 983-4323

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LC1500X | Community Health Nurse Practitioner | — | NULL | — |
| 363LC1500X | Community Health Nurse Practitioner | — | — | — |
| 385H00000X | Respite Care | — | NULL | Yes |

## Other

- **Enumeration date:** 07/22/2024
- **Last updated:** 07/22/2024