Healthcare Provider Details

I. General information

NPI: 1871552653
Provider Name (Legal Business Name): THE ELIZABETH CENTER FOR CANCER DETECTION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2006
Last Update Date: 02/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1127 WILSHIRE BLVD SUITE 1000
LOS ANGELES CA
90017-4001
US

IV. Provider business mailing address

1127 WILSHIRE BLVD SUITE 1000
LOS ANGELES CA
90017-4001
US

V. Phone/Fax

Practice location:
  • Phone: 213-481-2511
  • Fax: 213-481-1913
Mailing address:
  • Phone: 213-481-2511
  • Fax: 213-481-1913

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number960000031
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number960000031
License Number StateCA

VIII. Authorized Official

Name: DONALD M COOK
Title or Position: CEO
Credential:
Phone: 213-977-8920