Organization
INTERNATIONAL PRE-DIABETES CENTER INC
Active
Other names
Pre-Diabetes Professional Training Center, International Pre-Diabetes Center Inc.
Organization subpart
No
Provider details
NPI number
Authorized official
DR. YVONNE E. GRANT PHARM.D. APP, CDE, B (CHIEF EXECUTIVE OFFICER (CEO))
(818) 625-6756
Entity
Organization
Contact information
Practice address
14500 ROSCOE BLVD., 4TH FLOOR, 4TH FLOOR, PANORAMA CITY, CA 91402
(818) 714-2066
(818) 387-6224
Mailing address
14421 GLORIETTA DR, SHERMAN OAKS, CA 91423-4533
(818) 714-2066
(818) 387-6224
Taxonomy
Speciality
Code
Description
License number
State
163WD0400X
Diabetes Educator Registered Nurse
—
CA
174H00000X
Health Educator
—
CA
1835G0303X
Geriatric Pharmacist
10028
CA
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
38828
CA
251V00000X
Voluntary or Charitable Agency
—
CA
332B00000X
Durable Medical Equipment & Medical Supplies
38828
CA
332B00000X
Durable Medical Equipment & Medical Supplies
96123
CA
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1376080309
—
CA
01
—
200913353
CERTIFIED DIABETES EDUCATOR
CA
05
—
7658690001
—
CA
01
—
96123
DIABETES HOME MEDICAL DEVICE, DEPT. OF PUBLIC HEALTH, FOOD & DRUG BRANCH
CA
Enumeration date
01/29/2017
Last updated
12/22/2021
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