Healthcare Provider Details

I. General information

NPI: 1114967965
Provider Name (Legal Business Name): COUNTY OF LOS ANGELES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 01/05/2024
Certification Date: 01/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1212 PICO ST
SAN FERNANDO CA
91340-3503
US

IV. Provider business mailing address

313 N FIGUEROA ST STE 701
LOS ANGELES CA
90012-2602
US

V. Phone/Fax

Practice location:
  • Phone: 818-837-6945
  • Fax: 818-837-6952
Mailing address:
  • Phone: 213-240-7717
  • Fax: 213-975-9623

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPHE44724
License Number StateCA

VIII. Authorized Official

Name: AMY GUTIERREZ
Title or Position: CHIEF PHARMACY OFFICER
Credential:
Phone: 213-240-7717