Healthcare Provider Details

I. General information

NPI: 1912372475
Provider Name (Legal Business Name): LOS ANGELES COUNTY HOSPITAL OF UNIVERSITY OF SOURTHERN CALIFORNIA (LAC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2015
Last Update Date: 12/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4350 LOWELL AVE
LA CRESCENTA CA
91214-2363
US

IV. Provider business mailing address

4350 LOWELL AVE
LA CRESCENTA CA
91214-2363
US

V. Phone/Fax

Practice location:
  • Phone: 616-560-4326
  • Fax:
Mailing address:
  • Phone: 616-560-4326
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number139573
License Number StateCA

VIII. Authorized Official

Name: SUSAN ARNWINE
Title or Position: RESIDENCY SECRETARY
Credential:
Phone: 323-226-6937