Healthcare Provider Details

I. General information

NPI: 1326370073
Provider Name (Legal Business Name): EISNER PEDIATRIC AND FAMILY MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2010
Last Update Date: 02/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 S OLIVE ST
LOS ANGELES CA
90015-3023
US

IV. Provider business mailing address

1500 S OLIVE ST
LOS ANGELES CA
90015-3023
US

V. Phone/Fax

Practice location:
  • Phone: 213-747-5542
  • Fax: 213-746-9379
Mailing address:
  • Phone: 213-747-5542
  • Fax: 213-746-9379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number50156
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: NICOLE ALTON
Title or Position: PHARMACIST IN CHARGE
Credential:
Phone: 213-342-3333