Healthcare Provider Details

I. General information

NPI: 1942477757
Provider Name (Legal Business Name): LOS ANGELES SHERIFF'S DEPARTMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2008
Last Update Date: 05/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 BAUCHET ST
LOS ANGELES CA
90012-2907
US

IV. Provider business mailing address

19400 LANARK ST
RESEDA CA
91335-1013
US

V. Phone/Fax

Practice location:
  • Phone: 213-893-5455
  • Fax: 213-633-4663
Mailing address:
  • Phone: 818-885-0864
  • Fax: 818-885-0864

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number586319 NPC16628
License Number StateCA

VIII. Authorized Official

Name: MRS. MARIA OFELIA CRUZ DE PORTILLO
Title or Position: NURSE PRACTITIONER
Credential: NP
Phone: 213-893-5455