Healthcare Provider Details

I. General information

NPI: 1174977813
Provider Name (Legal Business Name): COUNTY OF LOS ANGELES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2016
Last Update Date: 01/15/2020
Certification Date: 01/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 W MANCHESTER BLVD
INGLEWOOD CA
90301-1753
US

IV. Provider business mailing address

123 W MANCHESTER BLVD
INGLEWOOD CA
90301-1753
US

V. Phone/Fax

Practice location:
  • Phone: 310-419-5325
  • Fax:
Mailing address:
  • Phone: 310-419-5325
  • 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: MR. QUENTIN O'BRIEN
Title or Position: ACN, CEO
Credential:
Phone: 213-288-9000