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General NPI Number Information
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NPI Number | 1497639231
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Entity Type | Organization
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Legal Business Name | THE LOS ANGELES FREE CLINIC
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Dates
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Enumeration Date | 08/04/2025
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Last Update Date | 09/04/2025
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Provider Practice Location Address
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Address Line | 1704 W MANCHESTER AVE STE 202A
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City | LOS ANGELES
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State | CA
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Zip | 90047-3057
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Country | US
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Telephone | 323-531-0565
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Fax |
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Provider Business Mailing Address
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Address Line | 8405 BEVERLY BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90048-3401
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Country | US
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Telephone | 323-653-1990
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MURIEL NOUWEZEM
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Credential |
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Telephone | 323-337-1707
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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