Provider Demographics
NPI:1548398134
Name:COUNTY OF LOS ANGELES AUDITOR CONTROLLER
Entity Type:Organization
Organization Name:COUNTY OF LOS ANGELES AUDITOR CONTROLLER
Other - Org Name:MARTIN LUTHER KING, JR. OUTPATIENT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:OLIVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:424-338-1001
Mailing Address - Street 1:1670 E 120TH ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90059-3026
Mailing Address - Country:US
Mailing Address - Phone:310-668-5201
Mailing Address - Fax:
Practice Address - Street 1:1670 E 120TH ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90059-3026
Practice Address - Country:US
Practice Address - Phone:310-668-5201
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF LOS ANGELES AUDITOR CONTROLLER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-02
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60000132282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========OtherMLKH HOSP OTHER ST PROG