Provider Demographics
NPI:1336281179
Name:THE LOS ANGELES FREE CLINIC
Entity Type:Organization
Organization Name:THE LOS ANGELES FREE CLINIC
Other - Org Name:SABAN COMMUNITY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:BUJER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-653-8622
Mailing Address - Street 1:5205 MELROSE AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90038-3144
Mailing Address - Country:US
Mailing Address - Phone:323-653-8622
Mailing Address - Fax:
Practice Address - Street 1:5205 MELROSE AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90038-3144
Practice Address - Country:US
Practice Address - Phone:323-653-8622
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA960001353261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABCP70654FMedicaid
CAFHC70654FMedicaid
CAHAP70701FMedicaid
CACMM70945FMedicaid
CAEAP00005FMedicaid
CABCP70701FMedicaid
CAFHC70701FMedicaid
CAHAP70654FMedicaid
CAHAP70654FMedicaid
CAFHC70654FMedicaid
CACMM70945FMedicaid