Provider Demographics
NPI:1164123907
Name:COUNTY OF LOS ANGELES
Entity Type:Organization
Organization Name:COUNTY OF LOS ANGELES
Other - Org Name:OFFICE OF DIVERSION AND REENTRY MENTAL HEALTH CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:VIET
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MPH
Authorized Official - Phone:213-418-3600
Mailing Address - Street 1:1000 S. FREMONT AVE., UNIT #9
Mailing Address - Street 2:BLDG A11, GROUND FL., SUITE A11010
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91803-8801
Mailing Address - Country:US
Mailing Address - Phone:626-525-6076
Mailing Address - Fax:
Practice Address - Street 1:222 S HILL ST FL 4
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90012-3508
Practice Address - Country:US
Practice Address - Phone:213-418-3600
Practice Address - Fax:213-437-0034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-16
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
00504OtherLE