Healthcare Provider Details

I. General information

NPI: 1124004304
Provider Name (Legal Business Name): ST VINCENT MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2005
Last Update Date: 10/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2131 W 3RD ST
LOS ANGELES CA
90057-1901
US

IV. Provider business mailing address

2131 W 3RD ST
LOS ANGELES CA
90057-1901
US

V. Phone/Fax

Practice location:
  • Phone: 213-484-7402
  • Fax:
Mailing address:
  • Phone: 213-484-7402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License NumberHSP 45704
License Number StateCA

VIII. Authorized Official

Name: NORMAN WILLIS
Title or Position: DIRECTOR OF PHARMACY
Credential:
Phone: 213-484-7111