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General NPI Number Information
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NPI Number | 1689079402
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Entity Type | Organization
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Legal Business Name | WHITE MEMORIAL MEDICAL CENTER
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Dates
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Enumeration Date | 10/23/2014
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Last Update Date | 10/23/2014
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Provider Practice Location Address
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Address Line | 1720 CESAR E. CHAVEZ AVENUE
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City | LOS ANGELES
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State | CA
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Zip | 90033
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Country | US
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Telephone | 323-260-5789
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Fax |
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Provider Business Mailing Address
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Address Line | 1720 CESAR E. CHAVEZ AVENUE
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City | LOS ANGELES
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State | CA
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Zip | 90033
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Country | US
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Telephone | 323-260-5789
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Fax |
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Authorized Official
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Title or Position | FAMILY MEDICINE PROGRAM DIRECTOR
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Name | DR. LUIS SAMANIEGO
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Credential | M.D.
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Telephone | 323-260-5789
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 20A13554
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License Number State | CA
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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 | 20A13554
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 284300000X
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Taxonomy Name | Special Hospital
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License Number | 20A13554
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License Number State | CA
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