MEDICARE: THE ELIZABETH CENTER FOR CANCER DETECTION

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	261QM1300X	Multi-Specialty Clinic/Center	960000031	CA
2	261QC1500X	Community Health Clinic/Center	960000031	CA

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	ZZZ53363Z	OTHER	CA	BLUE SHIELD OF CALIF

General Provider Information

NPI Number	:	1871552653
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE ELIZABETH CENTER FOR CANCER DETECTION

Provider Business Mailing Address
First Line	:	1127 WILSHIRE BLVD
Second Line	:	SUITE 1000
City	:	LOS ANGELES
State	:	CA
Zip	:	90017-4001
Country	:	US
Telephone Number	:	213-481-2511
Fax Number	:	213-481-1913

Provider Business Practice Location Address
First Line	:	1127 WILSHIRE BLVD
Second Line	:	SUITE 1000
City	:	LOS ANGELES
State	:	CA
Zip	:	90017-4001
Country	:	US
Telephone Number	:	213-481-2511
Fax Number	:	213-481-1913

Authorized Official
Title or Position	:	CEO
Name	:	DONALD M COOK
Credential	:
Telephone Number	:	213-977-8920

Provider Enumeration Date	:	03/21/2006
Last Update Date	:	02/17/2010

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Directions to “THE ELIZABETH CENTER FOR CANCER DETECTION ” Practice Location

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