Healthcare Provider Details

I. General information

NPI: 1558548743
Provider Name (Legal Business Name): LOS ANGELES DOCTORS CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2008
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2231 S WESTERN AVE
LOS ANGELES CA
90018-1302
US

IV. Provider business mailing address

2231 S WESTERN AVE
LOS ANGELES CA
90018-1302
US

V. Phone/Fax

Practice location:
  • Phone: 310-679-3321
  • Fax: 310-675-0120
Mailing address:
  • Phone: 310-679-3321
  • Fax: 310-675-0120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number StateCA

VIII. Authorized Official

Name: MRS. ASTRA JOHNSON
Title or Position: DIRECTOR OF THE BUSINESS OFFICE
Credential:
Phone: 310-679-3321