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General NPI Number Information
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NPI Number | 1598097495
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Entity Type | Organization
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Legal Business Name | LOS ANGELES COUNTY - PACIFIC BLVD. MTU
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Dates
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Enumeration Date | 02/03/2010
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Last Update Date | 02/03/2010
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Provider Practice Location Address
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Address Line | 2660 E 57TH STREET
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City | HUNTINGTON PARK
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State | CA
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Zip | 90255-4403
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Country | US
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Telephone | 323-286-1888
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Fax |
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Provider Business Mailing Address
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Address Line | 9320 TELSTAR AVE STE226
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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 | DIRECTOR, CMS
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Name | MR. WESLEY FORD
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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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