MEDICARE: HOLLYWOOD SUNSET 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	261QA0005X	Ambulatory Family Planning Facility		CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	EAP00008F	OTHER	CA	EAPC

General Provider Information

NPI Number	:	1679691810
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOLLYWOOD SUNSET FREE CLINIC

Provider Business Mailing Address
First Line	:	3324 W SUNSET BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90026-2118
Country	:	US
Telephone Number	:	323-660-7959
Fax Number	:	323-663-6410

Provider Business Practice Location Address
First Line	:	3324 W SUNSET BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90026-2118
Country	:	US
Telephone Number	:	323-660-7959
Fax Number	:	323-663-6410

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MS. TERESA PADUA
Credential	:
Telephone Number	:	323-660-7959

Provider Enumeration Date	:	03/26/2007
Last Update Date	:	08/22/2020

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Directions to “HOLLYWOOD SUNSET FREE CLINIC ” Practice Location

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