Healthcare Provider Details

I. General information

NPI: 1437160637
Provider Name (Legal Business Name): LOS ANGELES LGBT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 09/26/2024
Certification Date: 09/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 SCHRADER BLVD 1ST FLOOR
LOS ANGELES CA
90028-6213
US

IV. Provider business mailing address

1625 SCHRADER BLVD 1ST FLOOR
LOS ANGELES CA
90028-6213
US

V. Phone/Fax

Practice location:
  • Phone: 323-993-7513
  • Fax: 323-308-4444
Mailing address:
  • Phone: 323-993-7513
  • Fax: 323-308-4444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY-45118
License Number StateCA

VIII. Authorized Official

Name: ROBYN GOLDMAN
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 323-993-8948