Healthcare Provider Details

I. General information

NPI: 1639208192
Provider Name (Legal Business Name): COUNTY OF LOS ANGELES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 01/16/2020
Certification Date: 01/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 BROAD AVE
WILMINGTON CA
90744-2604
US

IV. Provider business mailing address

1325 BROAD AVE
WILMINGTON CA
90744-2604
US

V. Phone/Fax

Practice location:
  • Phone: 562-804-8101
  • Fax:
Mailing address:
  • Phone: 562-804-8101
  • 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: MR. QUENTIN O'BRIEN
Title or Position: ACN, CEO
Credential:
Phone: 213-288-9000