Healthcare Provider Details

I. General information

NPI: 1073124244
Provider Name (Legal Business Name): COUNTY OF LOS ANGELES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2020
Last Update Date: 09/30/2020
Certification Date: 09/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10953 RAMONA BLVD RM#: 1293, 1295A, 1160
EL MONTE CA
91731-2629
US

IV. Provider business mailing address

10953 RAMONA BLVD SECOND FL, ADMIN
EL MONTE CA
91731-2629
US

V. Phone/Fax

Practice location:
  • Phone: 626-434-2500
  • Fax:
Mailing address:
  • Phone: 626-434-2500
  • 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: QUENTIN O'BRIEN
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 213-288-9000