Provider Demographics
NPI:1992680185
Name:LITTLE, GLENESHIA 8206
Entity type:Individual
Prefix:
First Name:GLENESHIA
Middle Name:8206
Last Name:LITTLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5757 W CENTURY BLVD STE 700
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-6417
Mailing Address - Country:US
Mailing Address - Phone:562-743-8082
Mailing Address - Fax:
Practice Address - Street 1:5757 W CENTURY BLVD STE 700
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-6417
Practice Address - Country:US
Practice Address - Phone:562-743-8082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-07
Last Update Date:2025-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA833605201OtherUNSEEN FACES FOUNDATION INC