MEDICARE: MACARTHUR PARK MEDICAL CLINIC

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	261Q00000X	Clinic/Center	A30080	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083873855
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MACARTHUR PARK MEDICAL CLINIC

Provider Business Mailing Address
First Line	:	2228 W 7TH ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90057-4002
Country	:	US
Telephone Number	:	213-383-5773
Fax Number	:	213-383-5783

Provider Business Practice Location Address
First Line	:	2228 W 7TH ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90057-4002
Country	:	US
Telephone Number	:	213-383-5773
Fax Number	:	213-383-5783

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. ALICIA ZABELLA LAANO
Credential	:	MD
Telephone Number	:	213-383-5773

Provider Enumeration Date	:	06/05/2008
Last Update Date	:	06/05/2008

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Directions to “MACARTHUR PARK MEDICAL CLINIC ” Practice Location

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