Healthcare Provider Details

I. General information

NPI: 1144050097
Provider Name (Legal Business Name): METROPOLITAN DETENTION CENTER LOS ANGELES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2024
Last Update Date: 08/06/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 N. ALAMEDA ST.
LOS ANGELES CA
90012
US

IV. Provider business mailing address

535 N. ALAMEDA ST.
LOS ANGELES CA
90012
US

V. Phone/Fax

Practice location:
  • Phone: 213-485-0439
  • Fax:
Mailing address:
  • Phone: 213-485-0439
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QP2400X
TaxonomyPrison Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHARLES PARK
Title or Position: HEALTH SERVICE ADMINISTRATOR
Credential: PHARM.D.
Phone: 213-485-0439