Healthcare Provider Details

I. General information

NPI: 1801929757
Provider Name (Legal Business Name): HEALTH CARE LA, IPA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6400 CANOGA AVE SUITE 163
WOODLAND HILLS CA
91367-2425
US

IV. Provider business mailing address

PO BOX 570590
TARZANA CA
91357-0590
US

V. Phone/Fax

Practice location:
  • Phone: 818-702-0100
  • Fax: 818-702-9128
Mailing address:
  • Phone: 818-702-0100
  • Fax: 818-702-9128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State

VIII. Authorized Official

Name: MS. LINDA DEAKTOR
Title or Position: DIRECTOR OF MEDICAL AFFAIRS
Credential: RN
Phone: 818-702-0100