Provider Demographics
NPI:1164551230
Name:COUNTY OF LOS ANGELES AUDITOR CONTROLLER
Entity Type:Organization
Organization Name:COUNTY OF LOS ANGELES AUDITOR CONTROLLER
Other - Org Name:LAKE LOS ANGELES COMMUNITY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINIC ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-471-4200
Mailing Address - Street 1:16921 E AVENUE O STE G
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93591-3045
Mailing Address - Country:US
Mailing Address - Phone:661-945-8444
Mailing Address - Fax:
Practice Address - Street 1:16921 E AVENUE O STE G
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93591-3045
Practice Address - Country:US
Practice Address - Phone:661-945-8444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF LOS ANGELES AUDITOR CONTROLLER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-05
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========OtherLKLA HC COM INSURANCE