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General NPI Number Information
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NPI Number | 1285981902
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Entity Type | Organization
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Legal Business Name | LOS ANGELES COUNTY UNIVERSITY OF SOUTHERN CALIFORNIA MEDICAL CENTER
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Dates
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Enumeration Date | 08/13/2012
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Last Update Date | 08/13/2012
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Provider Practice Location Address
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Address Line | 1100 N STATE ST CLINIC TOWER, A6A231-A
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City | LOS ANGELES
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State | CA
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Zip | 90033-5000
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Country | US
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Telephone | 323-409-2345
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Fax |
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Provider Business Mailing Address
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Address Line | 1100 N STATE ST CLINIC TOWER, A6A231-A
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City | LOS ANGELES
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State | CA
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Zip | 90033-5000
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | MRS. TINA HUTTAYASOMBOON
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Credential | N.P.
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Telephone | 626-319-7554
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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 | 21685
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License Number State | CA
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