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General NPI Number Information
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NPI Number | 1326193848
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Entity Type | Organization
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Legal Business Name | LOS ANGELES COUNTY - MID-CITIES MTU
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Dates
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Enumeration Date | 01/24/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1417 S CENTRAL AVE
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City | COMPTON
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State | CA
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Zip | 90220-4102
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Country | US
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Telephone | 310-763-9147
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Fax |
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Provider Business Mailing Address
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Address Line | 9320 TELSTAR AVE STE 226
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City | EL MONTE
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State | CA
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Zip | 91731-2849
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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 | ACTING DIRECTOR, CMS
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Name | SHAVONDA WEBBER-CHRISTMAS
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Credential |
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Telephone | 626-569-6001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number |
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License Number State |
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