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General NPI Number Information
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NPI Number | 1730969031
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Entity Type | Organization
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Legal Business Name | COUNTY OF LOS ANGELES
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Dates
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Enumeration Date | 10/03/2023
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Last Update Date | 10/03/2023
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Provider Practice Location Address
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Address Line | 450 BAUCHET ST, 8TH FLOOR, ROOM E815
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City | LOS ANGELES
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State | CA
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Zip | 90012
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Country | US
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Telephone | 213-893-5883
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Fax | 213-633-4663
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Provider Business Mailing Address
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Address Line | 1000 S. FREMONT AVE., UNIT #9 BLDG A11, GROUND FL, SUITE A11010
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City | ALHAMBRA
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State | CA
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Zip | 91803-8801
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Country | US
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Telephone | 626-525-6076
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Fax |
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Authorized Official
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Title or Position | CHIEF MEDICAL OFFICER
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Name | SEAN HENDERSON
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Credential | MD
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Telephone | 213-893-5304
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2400X
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Taxonomy Name | Prison Health Clinic/Center
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License Number |
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License Number State |
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