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General NPI Number Information
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NPI Number | 1942477757
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Entity Type | Organization
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Legal Business Name | LOS ANGELES SHERIFF'S DEPARTMENT
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Dates
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Enumeration Date | 05/12/2008
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Last Update Date | 05/12/2008
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Provider Practice Location Address
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Address Line | 450 BAUCHET ST
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City | LOS ANGELES
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State | CA
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Zip | 90012-2907
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Country | US
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Telephone | 213-893-5455
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Fax | 213-633-4663
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Provider Business Mailing Address
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Address Line | 19400 LANARK ST
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City | RESEDA
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State | CA
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Zip | 91335-1013
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Country | US
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Telephone | 818-885-0864
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Fax | 818-885-0864
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | MRS. MARIA OFELIA CRUZ DE PORTILLO
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Credential | NP
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Telephone | 213-893-5455
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 586319 NPC16628
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License Number State | CA
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