Basic Information
| Provider Information | |||||||||
| NPI: | 1174549711 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LOS ANGELES COUNTY - DEPARTMENT OF HEALTH SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5555 FERGUSON DR | ||||||||
| Address2: | SUITE 310-15 | ||||||||
| City: | COMMERCE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900225152 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3238907775 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5850 S MAIN ST | ||||||||
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| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900031215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3238464312 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/15/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | BERNAL | ||||||||
| AuthorizedOfficialFirstName: | ART | ||||||||
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| AuthorizedOfficialTitleorPosition: | ASSOCIATE HOSPITAL ADMINISTRATOR II | ||||||||
| AuthorizedOfficialTelephone: | 3238907775 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.