Healthcare Provider Details

I. General information

NPI: 1689192791
Provider Name (Legal Business Name): COUNTY OF LOS ANGELES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2017
Last Update Date: 02/11/2022
Certification Date: 02/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 W CARSON ST. PCDC MODULE B&C
TORRANCE CA
90502
US

IV. Provider business mailing address

1000 W CARSON ST BOX 459
TORRANCE CA
90502
US

V. Phone/Fax

Practice location:
  • Phone: 424-306-4546
  • Fax:
Mailing address:
  • Phone: 310-532-7600
  • 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: ANISH MAHAJAN
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: MD
Phone: 424-306-6580