Basic Information
| Provider Information | |||||||||
| NPI: | 1730712902 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WHITE MEMORIAL COMMUNITY HEALTH CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1828 E CESAR E CHAVEZ AVE STE 6100 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900332597 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3238593627 | ||||||||
| FaxNumber: | 3239871212 | ||||||||
| Practice Location | |||||||||
| Address1: | 1828 E CESAR E CHAVEZ AVE STE 4300 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900332400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3239871200 | ||||||||
| FaxNumber: | 3239871212 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/17/2020 | ||||||||
| LastUpdateDate: | 02/17/2020 | ||||||||
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| AuthorizedOfficialLastName: | ANZUETO | ||||||||
| AuthorizedOfficialFirstName: | INGRID | ||||||||
| AuthorizedOfficialMiddleName: | A. | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE ASSISTANT | ||||||||
| AuthorizedOfficialTelephone: | 3238593627 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | WHITE MEMORIAL COMMUNITY HEALTH CENTER | ||||||||
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| NPICertificationDate: | 02/17/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.