Provider Demographics
NPI:1043656234
Name:YOUNG MEN'S CHRISTIAN ASSOCIATION OF METROPOLITAN LOS ANGELES
Entity Type:Organization
Organization Name:YOUNG MEN'S CHRISTIAN ASSOCIATION OF METROPOLITAN LOS ANGELES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EVP, CHIEF MISSION ADVANCEMENT OFC.
Authorized Official - Prefix:
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:DOMINGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-380-6448
Mailing Address - Street 1:625 S NEW HAMPSHIRE AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90005-1342
Mailing Address - Country:US
Mailing Address - Phone:213-380-6448
Mailing Address - Fax:
Practice Address - Street 1:625 S NEW HAMPSHIRE AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90005-1342
Practice Address - Country:US
Practice Address - Phone:213-380-6448
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-15
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty