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General NPI Number Information
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NPI Number | 1154047553
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Entity Type | Organization
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Legal Business Name | DE LONGPRE MEDICAL CENTER INC
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Dates
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Enumeration Date | 10/17/2022
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Last Update Date | 10/17/2022
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Provider Practice Location Address
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Address Line | 326 N VERMONT AVE STE A
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City | LOS ANGELES
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State | CA
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Zip | 90004-3511
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Country | US
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Telephone | 323-666-1276
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Fax |
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Provider Business Mailing Address
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Address Line | 326 N VERMONT AVE STE A
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City | LOS ANGELES
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State | CA
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Zip | 90004-3511
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Country | US
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Telephone | 323-666-1276
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Fax |
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | MICHELE SHAMELL
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Credential |
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Telephone | 888-585-5510
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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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 | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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