Healthcare Provider Details

I. General information

NPI: 1386382430
Provider Name (Legal Business Name): COUNTY OF LOS ANGELES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2022
Last Update Date: 05/26/2022
Certification Date: 05/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1212 PICO ST
SAN FERNANDO CA
91340-3503
US

IV. Provider business mailing address

1000 S. FREMONT AVE., UNIT #9 BLDG A11, GROUND FL., SUITE A11010
ALHAMBRA CA
91803-8801
US

V. Phone/Fax

Practice location:
  • Phone: 818-627-3050
  • Fax:
Mailing address:
  • Phone: 626-525-6076
  • 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: QUENTIN O'BRIEN
Title or Position: AMBULATORY NETWORK, CEO
Credential:
Phone: 213-288-9000