Healthcare Provider Details

I. General information

NPI: 1518589266
Provider Name (Legal Business Name): COUNTY OF LOS ANGELES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2020
Last Update Date: 05/15/2020
Certification Date: 05/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1359 N GRAND AVE
COVINA CA
91724-1016
US

IV. Provider business mailing address

5555 FERGUSON DR STE 310-15
COMMERCE CA
90022-5164
US

V. Phone/Fax

Practice location:
  • Phone: 626-430-2900
  • Fax:
Mailing address:
  • Phone: 323-914-7773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL OWENS
Title or Position: DIRECTOR, EDIM
Credential:
Phone: 213-288-8695