Healthcare Provider Details

I. General information

NPI: 1235599598
Provider Name (Legal Business Name): WHITE MEMORIAL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/29/2016
Last Update Date: 02/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

259 N EUCLID AVE APT 12
PASADENA CA
91101-1516
US

IV. Provider business mailing address

259 N EUCLID AVE APT 12
PASADENA CA
91101-1516
US

V. Phone/Fax

Practice location:
  • Phone: 323-226-1100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberA140212
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License NumberA140212
License Number StateCA

VIII. Authorized Official

Name: DR. LUCILA TARIN
Title or Position: PROGRAM DIRECTOR
Credential:
Phone: 323-226-1100