MEDICARE: LAC/USC MEDICAL CENTER

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	282N00000X	General Acute Care Hospital	A98135	CA

General Provider Information

NPI Number	:	1639354301
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAC/USC MEDICAL CENTER

Provider Business Mailing Address
First Line	:	1201 NORTH STATE ST.
Second Line	:	3550
City	:	LOS ANGELES
State	:	CA
Zip	:	90033
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1201 NORTH STATE STREET
Second Line	:	3550
City	:	LOS ANGELES
State	:	CA
Zip	:	90033-0000
Country	:	US
Telephone Number	:	323-226-7257
Fax Number	:

Authorized Official
Title or Position	:	RESIDENT
Name	:	CAMERON MANBEIAN
Credential	:	M.D.
Telephone Number	:	323-226-7257

Provider Enumeration Date	:	12/31/2007
Last Update Date	:	12/31/2007

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