Basic Information
| Provider Information | |||||||||
| NPI: | 1194288852 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | COUNTY OF LOS ANGELES - AUDITOR CONTROLLER | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | DMC-ODS | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1403 LOMITA BLVD | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | HARBOR CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90710 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3105346221 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1403 LOMITA BLVD | ||||||||
| Address2: | SUITE 102, ROOMS 1-26 & CONFERENCE ROOM | ||||||||
| City: | HARBOR CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90710 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3105346221 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/10/2019 | ||||||||
| LastUpdateDate: | 04/11/2019 | ||||||||
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| AuthorizedOfficialLastName: | PEREZ | ||||||||
| AuthorizedOfficialFirstName: | VIRGINIA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF-CONSOLIDATED BUSINESS OFFICE | ||||||||
| AuthorizedOfficialTelephone: | 3239147622 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | COUNTY OF LOS ANGELES-AUDITOR CONTROLLER | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | Y | Ambulatory Health Care Facilities | Clinic/Center |
No ID Information.