Basic Information
| Provider Information | |||||||||
| NPI: | 1891976247 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HUBERT HUMPHREY MEDICAL CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5850 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900031215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3238464265 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5850 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900031215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3238464265 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/14/2007 | ||||||||
| LastUpdateDate: | 11/14/2007 | ||||||||
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| AuthorizedOfficialLastName: | BOWEN | ||||||||
| AuthorizedOfficialFirstName: | NARAI | ||||||||
| AuthorizedOfficialMiddleName: | MARIE | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN ASSISTANT | ||||||||
| AuthorizedOfficialTelephone: | 3234228941 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | PA-C | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QU0200X | PA19172 | CA | Y | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care |
No ID Information.