MEDICARE: YOUNG MEN'S CHRISTIAN ASSOCIATION OF METROPOLITAN LOS ANGELES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174H00000X	Health Educator

General Provider Information

NPI Number	:	1043656234
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YOUNG MEN'S CHRISTIAN ASSOCIATION OF METROPOLITAN LOS ANGELES

Provider Business Mailing Address
First Line	:	625 S NEW HAMPSHIRE AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90005-1342
Country	:	US
Telephone Number	:	213-380-6448
Fax Number	:

Provider Business Practice Location Address
First Line	:	625 S NEW HAMPSHIRE AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90005-1342
Country	:	US
Telephone Number	:	213-380-6448
Fax Number	:

Authorized Official
Title or Position	:	EVP, CHIEF MISSION ADVANCEMENT OFC.
Name	:	VICTOR DOMINGUEZ
Credential	:
Telephone Number	:	213-380-6448

Provider Enumeration Date	:	05/15/2013
Last Update Date	:	03/17/2017

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