Healthcare Provider Details

I. General information

NPI: 1467057166
Provider Name (Legal Business Name): LOS ANGELES LGBT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2020
Last Update Date: 10/23/2025
Certification Date: 10/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2313 W MARTIN LUTHER KING JR BLVD
LOS ANGELES CA
90008-2724
US

IV. Provider business mailing address

1625 SCHRADER BLVD
LOS ANGELES CA
90028-6213
US

V. Phone/Fax

Practice location:
  • Phone: 323-860-3799
  • Fax:
Mailing address:
  • Phone: 323-993-7605
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: ROBYN GOLDMAN
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 323-993-8948