Basic Information
| Provider Information | |||||||||
| NPI: | 1790396968 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COUNTY OF LOS ANGELES | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | OLIVE VIEW-UCLA MEDICAL CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14445 OLIVE VIEW DR | ||||||||
| Address2: | SUITE 2C155 | ||||||||
| City: | SYLMAR | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913421437 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3239147773 | ||||||||
| FaxNumber: | 7472103044 | ||||||||
| Practice Location | |||||||||
| Address1: | 14445 OLIVE VIEW DR | ||||||||
| Address2: | CLINIC A EXAM ROOM 1-11 | ||||||||
| City: | SYLMAR | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913421438 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7472103300 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/12/2020 | ||||||||
| LastUpdateDate: | 08/28/2020 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | MATEVOSIAN | ||||||||
| AuthorizedOfficialFirstName: | RIMA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF MEDICAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 7472104350 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | COUNTY OF LOS ANGELES | ||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 08/28/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | Y | Hospitals | General Acute Care Hospital |
No ID Information.