Provider Demographics
NPI:1538042387
Name:SO FIT
Entity type:Organization
Organization Name:SO FIT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LORETTA A.
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-922-6332
Mailing Address - Street 1:8939 S SEPULVEDA BLVD STE 110-782
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-3631
Mailing Address - Country:US
Mailing Address - Phone:310-922-6332
Mailing Address - Fax:
Practice Address - Street 1:4428 W SLAUSON AVE STE 4
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90043-2718
Practice Address - Country:US
Practice Address - Phone:310-922-6332
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-29
Last Update Date:2025-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1800XAmbulatory Health Care FacilitiesClinic/CenterCorporate Health