Healthcare Provider Details

I. General information

NPI: 1982919528
Provider Name (Legal Business Name): COUNTY OF LOS ANGELES AUDITOR CONTROLLER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2010
Last Update Date: 03/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16921 E AVENUE O STE G
PALMDALE CA
93591-3045
US

IV. Provider business mailing address

16921 E AVENUE O STE G
PALMDALE CA
93591-3045
US

V. Phone/Fax

Practice location:
  • Phone: 661-945-8444
  • Fax:
Mailing address:
  • Phone: 661-945-8444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. BERYL BROOKS
Title or Position: CLINIC ADMINISTRATOR
Credential:
Phone: 661-471-4200