Basic Information
| Provider Information | |||||||||
| NPI: | 1255829271 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | COUNTY OF LOS ANGELES - AUDITOR CONTROLLER | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | EAST SAN GABRIEL VALLEY SATELLITE MEDICAL HUB | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5555 FERGUSON DR STE 310-15 | ||||||||
| Address2: | |||||||||
| City: | COMMERCE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900225164 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3239147365 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4024 NORTH DURFEE RD | ||||||||
| Address2: | |||||||||
| City: | EL MONTE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 91732 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6264508930 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/25/2018 | ||||||||
| LastUpdateDate: | 04/25/2018 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | ALBERT | ||||||||
| AuthorizedOfficialFirstName: | FRANK | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF REVENUE MANAGEMENT, HEALTH SV | ||||||||
| AuthorizedOfficialTelephone: | 2132887950 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | COUNTY OF LOS ANGELES - AUDITOR CONTROLLER | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2300X | CA | Y | Ambulatory Health Care Facilities | Clinic/Center | Primary Care |
No ID Information.