Basic Information
| Provider Information | |||||||||
| NPI: | 1386382430 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COUNTY OF LOS ANGELES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1000 S. FREMONT AVE., UNIT #9 | ||||||||
| Address2: | BLDG A11, GROUND FL., SUITE A11010 | ||||||||
| City: | ALHAMBRA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 918038801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6265256076 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1212 PICO ST | ||||||||
| Address2: | |||||||||
| City: | SAN FERNANDO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913403503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8186273050 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/26/2022 | ||||||||
| LastUpdateDate: | 05/26/2022 | ||||||||
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| AuthorizedOfficialLastName: | O'BRIEN | ||||||||
| AuthorizedOfficialFirstName: | QUENTIN | ||||||||
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| AuthorizedOfficialTitleorPosition: | AMBULATORY NETWORK, CEO | ||||||||
| AuthorizedOfficialTelephone: | 2132889000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 05/09/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | Y | Ambulatory Health Care Facilities | Clinic/Center |
No ID Information.