Provider Demographics
NPI:1083873855
Name:MACARTHUR PARK MEDICAL CLINIC
Entity Type:Organization
Organization Name:MACARTHUR PARK MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:ZABELLA
Authorized Official - Last Name:LAANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:213-383-5773
Mailing Address - Street 1:2228 W 7TH ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057-4002
Mailing Address - Country:US
Mailing Address - Phone:213-383-5773
Mailing Address - Fax:213-383-5783
Practice Address - Street 1:2228 W 7TH ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-4002
Practice Address - Country:US
Practice Address - Phone:213-383-5773
Practice Address - Fax:213-383-5783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-05
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA30080261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR00786500Medicaid
CA8814330OtherMEDICAID PIN
CAW6544AMedicare PIN
CA8814330OtherMEDICAID PIN