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1235271065

NPI Code Detail

MEDICARE: THE LOS ANGELES FREE CLINIC

MEDICARE: THE LOS ANGELES FREE CLINIC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QC1500X	Community Health Clinic/Center	960000818	CA
2	261QF0400X	Federally Qualified Health Center (FQHC)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235271065
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE LOS ANGELES FREE CLINIC

Provider Business Mailing Address
First Line	:	6043 HOLLYWOOD BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90028-5411
Country	:	US
Telephone Number	:	323-653-8622
Fax Number	:

Provider Business Practice Location Address
First Line	:	6043 HOLLYWOOD BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90028-5411
Country	:	US
Telephone Number	:	323-653-8622
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MURIEL NOUWEZEM
Credential	:
Telephone Number	:	323-337-1707

Provider Enumeration Date	:	02/12/2007
Last Update Date	:	08/30/2024

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Directions to “THE LOS ANGELES FREE CLINIC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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