Healthcare Provider Details

I. General information

NPI: 1043432347
Provider Name (Legal Business Name): COUNTY OF LOS ANGELES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 10/03/2023
Certification Date: 10/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

441 BAUCHET ST, ROOM 6118
LOS ANGELES CA
90012-2906
US

IV. Provider business mailing address

1000 S. FREMONT. AVE., UNIT #9 BLDG A11, GROUND FL, SUITE A11010
ALHAMBRA CA
91803-8801
US

V. Phone/Fax

Practice location:
  • Phone: 213-893-5566
  • Fax: 213-893-5494
Mailing address:
  • Phone: 626-525-6076
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH 45961
License Number StateCA

VIII. Authorized Official

Name: SEAN HENDERSON
Title or Position: CHIEF MEDICAL OFFICER
Credential: MD
Phone: 213-893-5566