Healthcare Provider Details

I. General information

NPI: 1346111663
Provider Name (Legal Business Name): LOS ANGELES GENERAL MEDICAL CENTER FOUNDATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2025
Last Update Date: 09/17/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N STATE ST # 1008
LOS ANGELES CA
90089-1001
US

IV. Provider business mailing address

1200 N STATE ST # 1008
LOS ANGELES CA
90089-1001
US

V. Phone/Fax

Practice location:
  • Phone: 213-784-9191
  • Fax:
Mailing address:
  • Phone: 213-784-9191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name: MS. ROSA SOTO
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 213-784-9252