Basic Information
| Provider Information | |||||||||
| NPI: | 1780183335 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | L. A. DOWNTOWN MEDICAL CENTER, LLC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5004 | ||||||||
| Address2: | |||||||||
| City: | GLENDORA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917400019 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5624266141 | ||||||||
| FaxNumber: | 5624265269 | ||||||||
| Practice Location | |||||||||
| Address1: | 1711 W TEMPLE ST | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900265421 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2139896100 | ||||||||
| FaxNumber: | 5624265269 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/09/2018 | ||||||||
| LastUpdateDate: | 02/22/2019 | ||||||||
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| AuthorizedOfficialLastName: | ROLLINS | ||||||||
| AuthorizedOfficialFirstName: | VICKI | ||||||||
| AuthorizedOfficialMiddleName: | P | ||||||||
| AuthorizedOfficialTitleorPosition: | VICE-PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5624266141 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MISS | ||||||||
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| AuthorizedOfficialCredential: | RN | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 273R00000X | N | Hospital Units | Psychiatric Unit | 282N00000X | CA | Y | Hospitals | General Acute Care Hospital |
No ID Information.