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General NPI Number Information
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NPI Number | 1083895627
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Entity Type | Organization
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Legal Business Name | PIH HEALTH GOOD SAMARITAN HOSPITAL
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Dates
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Enumeration Date | 11/26/2007
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Last Update Date | 11/29/2023
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Provider Practice Location Address
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Address Line | 1225 WILSHIRE BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90017-1901
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Country | US
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Telephone | 213-977-2121
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Fax | 213-202-7118
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Provider Business Mailing Address
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Address Line | 1225 WILSHIRE BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90017-1901
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Country | US
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Telephone | 213-977-2121
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Fax | 213-202-7118
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Authorized Official
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Title or Position | SPECIAL PROJECTS
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Name | SUSANNE (SUE) R PONCE (AKA CARLSON)
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Credential |
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Telephone | 562-698-0811
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 930000071
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License Number State | CA
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