Organization
LL PROVIDER INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LORNA LOGAN (FOUNDER)
(949) 861-0127
Entity
Organization
Contact information
Practice address
12668 CHAPMAN AVE UNIT 2107, GARDEN GROVE, CA 92840-4037
(949) 861-0127
Mailing address
12668 CHAPMAN AVE UNIT 2107, GARDEN GROVE, CA 92840-4037
(949) 861-0127
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Enumeration date
12/29/2022
Last updated
12/29/2022
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