Provider Demographics
NPI:1043668023
Name:DEPARTMENT OF HEALTH SERVICES
Entity Type:Organization
Organization Name:DEPARTMENT OF HEALTH SERVICES
Other - Org Name:LOS ANGELES COUNTY SHERIFF'S DEPARTMENT
Other - Org Type:Other Name
Authorized Official - Title/Position:NURSE PRACTITIONER WHCNP
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:M
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:BSN, PHN, MSN, NP
Authorized Official - Phone:310-702-4285
Mailing Address - Street 1:450 BAUCHET ST
Mailing Address - Street 2:MSB ----ROOM E873
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90012-2907
Mailing Address - Country:US
Mailing Address - Phone:323-568-4550
Mailing Address - Fax:
Practice Address - Street 1:450 BAUCHET ST
Practice Address - Street 2:MSB ----ROOM E873
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90012-2907
Practice Address - Country:US
Practice Address - Phone:323-568-4550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-31
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14185261QP2400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2400XAmbulatory Health Care FacilitiesClinic/CenterPrison Health