Healthcare Provider Details

I. General information

NPI: 1780974790
Provider Name (Legal Business Name): LAC-USC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2011
Last Update Date: 04/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N. STATE ST., IRD 620, LAC -USC MED CENTER,
LOS ANGELES CA
90033
US

IV. Provider business mailing address

1200 N. STATE ST., IRD 620, LAC -USC MED CENTER
LOS ANGELES CA
90033
US

V. Phone/Fax

Practice location:
  • Phone: 323-226-7556
  • Fax: 323-226-2657
Mailing address:
  • Phone: 323-226-7556
  • Fax: 323-226-2657

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberA116505
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code281P00000X
TaxonomyChronic Disease Hospital
License NumberA116505
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License NumberA116505
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License NumberA116505
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. RON BEN-ARI
Title or Position: PROGRAM DIRECTOR
Credential: M.D.
Phone: 323-226-7556