Basic Information
Provider Information | |||||||||
NPI: | 1487697215 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | ST.FRANCIS MEDICAL CENTER | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 3630 E IMPERIAL HWY | ||||||||
Address2: |   | ||||||||
City: | LYNWOOD | ||||||||
State: | CA | ||||||||
PostalCode: | 902622609 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3109007421 | ||||||||
FaxNumber: | 3106036586 | ||||||||
Practice Location | |||||||||
Address1: | 3630 E IMPERIAL HWY | ||||||||
Address2: |   | ||||||||
City: | LYNWOOD | ||||||||
State: | CA | ||||||||
PostalCode: | 902624018 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3109007421 | ||||||||
FaxNumber: | 3106036586 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/13/2006 | ||||||||
LastUpdateDate: | 07/21/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | BASTOS | ||||||||
AuthorizedOfficialFirstName: | CARMEN | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | PATIENT FINANCIAL SERVICES DIRECTOR | ||||||||
AuthorizedOfficialTelephone: | 3109007421 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | MRS. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X |   | CA | Y |   | Hospitals | General Acute Care Hospital |   |
ID Information
ID | Type | State | Issuer | Description | ZZT30104G | 05 | CA |   | MEDICAID | LTC55238G | 05 | CA |   | MEDICAID | ZZT40104G | 05 | CA |   | MEDICAID | HSC30104G | 05 | CA |   | MEDICAID | HSM30104G | 05 | CA |   | MEDICAID |