Basic Information
| Provider Information | |||||||||
| NPI: | 1972252054 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEGENS | ||||||||
| FirstName: | ANDREW | ||||||||
| MiddleName: | ROBIN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7120 LEXINGTON AVE APT 5 | ||||||||
| Address2: | |||||||||
| City: | WEST HOLLYWOOD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900465837 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1625 SCHRADER BLVD | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900286213 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3239937500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/23/2022 | ||||||||
| LastUpdateDate: | 04/27/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/27/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WC0400X | 95240755 | CA | N | Nursing Service Providers | Registered Nurse | Case Management | 163W00000X | 95240755 | CA | Y | Nursing Service Providers | Registered Nurse |
No ID Information.