Healthcare Provider Details

I. General information

NPI: 1801048186
Provider Name (Legal Business Name): LAS-USC MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2008
Last Update Date: 10/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1240 N MISSION RD
LOS ANGELES CA
90033-1019
US

IV. Provider business mailing address

1240 N MISSION RD
LOS ANGELES CA
90033-1019
US

V. Phone/Fax

Practice location:
  • Phone: 323-226-3691
  • Fax:
Mailing address:
  • Phone: 323-226-3691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC2000X
TaxonomyChildren's Hospital
License NumberA53566
License Number StateCA

VIII. Authorized Official

Name: MISS DIANA ROMAN
Title or Position: SECRETARY
Credential:
Phone: 323-226-3961