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General NPI Number Information
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NPI Number | 1699175364
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Entity Type | Organization
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Legal Business Name | RAND SCHRADER 5P21 CLINIC
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Dates
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Enumeration Date | 08/29/2014
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Last Update Date | 08/29/2014
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Provider Practice Location Address
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Address Line | 1300 N MISSION RD
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City | LOS ANGELES
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State | CA
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Zip | 90033-1021
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Country | US
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Telephone | 323-343-8255
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Fax |
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Provider Business Mailing Address
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Address Line | 811 S WILTON PL APT 7
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City | LOS ANGELES
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State | CA
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Zip | 90005-3544
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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 MANAGER
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Name | LANOMAY BENJAMIN
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Credential | RN
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Telephone | 323-343-8255
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number | 272539
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License Number State | CA
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