Healthcare Provider Details

I. General information

NPI: 1457437154
Provider Name (Legal Business Name): CITY OF ANGELS EMERGENCY MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 11/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1711 W TEMPLE ST
LOS ANGELES CA
90026-5421
US

IV. Provider business mailing address

PO BOX 800817
SANTA CLARITA CA
91380-0817
US

V. Phone/Fax

Practice location:
  • Phone: 213-989-6160
  • Fax:
Mailing address:
  • Phone: 661-295-0859
  • Fax: 661-295-0862

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License NumberA25772
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License NumberA25772
License Number StateCA

VIII. Authorized Official

Name: DR. LOUIS ACOSTA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 213-989-6160