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General NPI Number Information
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NPI Number | 1801030804
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Entity Type | Organization
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Legal Business Name | LAC USC
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Dates
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Enumeration Date | 04/22/2009
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Last Update Date | 04/22/2009
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Provider Practice Location Address
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Address Line | 2020 ZONAL AVE IRD BUILDING,INTERNAL MEDICINE DEPARTMENT
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City | LOS ANGELES
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State | CA
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Zip | 90089-0121
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Country | US
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Telephone | 323-226-7556
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Fax |
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Provider Business Mailing Address
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Address Line | 18417 JEFFREY AVE
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City | CERRITOS
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State | CA
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Zip | 90703-6150
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Country | US
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Telephone | 562-402-0727
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Fax |
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Authorized Official
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Title or Position | PROGRAM DIRECTOR
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Name | DR. RON BEN -ARI
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Credential | M.D.
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Telephone | 323-226-7556
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | A105552
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | A105552
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License Number State | CA
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