Basic Information
| Provider Information | |||||||||
| NPI: | 1225299522 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LAC USC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 410 S EUCLID AVE | ||||||||
| Address2: | APT#2 | ||||||||
| City: | PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 911013159 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6266795256 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2020 ZONAL AVE # IRD620 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900890121 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3232267556 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/19/2008 | ||||||||
| LastUpdateDate: | 04/28/2009 | ||||||||
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| AuthorizedOfficialLastName: | BEN-ARI | ||||||||
| AuthorizedOfficialFirstName: | RON | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | INTERNAL MEDICINE PROGRAM DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 3232267556 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | A103771 | CA | Y | Hospitals | General Acute Care Hospital |
No ID Information.