MEDICARE: LOS ANGELES COUNTY PROBATION

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	251S00000X	Community/Behavioral Health Agency	171M00000X	CA

General Provider Information

NPI Number	:	1558534727
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOS ANGELES COUNTY PROBATION

Provider Business Mailing Address
First Line	:	11234 VALLEY BLVD
Second Line	:
City	:	EL MONTE
State	:	CA
Zip	:	91731-3241
Country	:	US
Telephone Number	:	626-575-4028
Fax Number	:

Provider Business Practice Location Address
First Line	:	11234 VALLEY BLVD
Second Line	:
City	:	EL MONTE
State	:	CA
Zip	:	91731-3241
Country	:	US
Telephone Number	:	626-575-4028
Fax Number	:

Authorized Official
Title or Position	:	SUPERVISING DEPUTY PROBATION OFFICE
Name	:	MR. KWADWO AKOSAH
Credential	:
Telephone Number	:	626-575-4028

Provider Enumeration Date	:	04/09/2008
Last Update Date	:	04/09/2008

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1124292925 — MARLENE CARRASCO DEPUTY PROB OFFICER
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1043461072 — LOS ANGELES COUNTY PROBATION DEPARTMENT
Practice Location Address:

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1639315351 — MRS. BRENDA MARIE WOODS
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Directions to “LOS ANGELES COUNTY PROBATION ” Practice Location

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