Healthcare Provider Details

I. General information

NPI: 1962109033
Provider Name (Legal Business Name): LOS ANGELES COUNTY DEPARTMENT OF PUBLIC HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2023
Last Update Date: 10/31/2024
Certification Date: 10/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

241 N FIGUEROA ST
LOS ANGELES CA
90012-2601
US

IV. Provider business mailing address

5555 FERGUSON DR STE 100-50
COMMERCE CA
90022-5152
US

V. Phone/Fax

Practice location:
  • Phone: 213-240-8204
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP0905X
TaxonomyState or Local Public Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: NAMAN SHAH
Title or Position: DIR, DIV OF MED & DENTAL AFFAIRS
Credential: MD
Phone: 213-240-8220