Provider Demographics
NPI:1114967965
Name:COUNTY OF LOS ANGELES
Entity Type:Organization
Organization Name:COUNTY OF LOS ANGELES
Other - Org Name:LOS ANGELES CO SAN FERNANDO PHCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF PHARMACY OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:GUTIERREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-240-7717
Mailing Address - Street 1:313 N FIGUEROA ST STE 701
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90012-2602
Mailing Address - Country:US
Mailing Address - Phone:213-240-7717
Mailing Address - Fax:213-975-9623
Practice Address - Street 1:1212 PICO ST
Practice Address - Street 2:
Practice Address - City:SAN FERNANDO
Practice Address - State:CA
Practice Address - Zip Code:91340-3503
Practice Address - Country:US
Practice Address - Phone:818-837-6945
Practice Address - Fax:818-837-6952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-08
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHE44724333600000X
3336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1995684OtherPK