MEDICARE: LOS ANGELES COUNTY - PEREZ MTU

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	261QR0400X	Rehabilitation Clinic/Center

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

General Provider Information

NPI Number	:	1740335157
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOS ANGELES COUNTY - PEREZ MTU

Provider Business Mailing Address
First Line	:	9320 TELSTAR AVE STE 226
Second Line	:
City	:	EL MONTE
State	:	CA
Zip	:	91731-2849
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4540 MICHIGAN AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90022-1130
Country	:	US
Telephone Number	:	323-264-5074
Fax Number	:

Authorized Official
Title or Position	:	ACTING DIRECTOR, CMS
Name	:	SHAVONDA WEBBER-CHRISTMAS
Credential	:
Telephone Number	:	626-569-6001

Provider Enumeration Date	:	01/24/2007
Last Update Date	:	08/22/2020

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