Healthcare Provider Details

I. General information

NPI: 1104259936
Provider Name (Legal Business Name): COUNTYOF LOS ANGELES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2013
Last Update Date: 08/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5555 FERGUSON DR
COMMERCE CA
90022-5164
US

IV. Provider business mailing address

501 N GLENDALE AVE
GLENDALE CA
91206-3312
US

V. Phone/Fax

Practice location:
  • Phone: 323-890-7509
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: ART BERNAL
Title or Position: CBO MANAGER
Credential:
Phone: 323-890-7775