Provider Demographics
NPI:1558548743
Name:LOS ANGELES DOCTORS CORP
Entity Type:Organization
Organization Name:LOS ANGELES DOCTORS CORP
Other - Org Name:LOS ANGELES METROPOLITAN MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF THE BUSINESS OFFICE
Authorized Official - Prefix:MRS
Authorized Official - First Name:ASTRA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-679-3321
Mailing Address - Street 1:2231 S WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90018-1302
Mailing Address - Country:US
Mailing Address - Phone:310-679-3321
Mailing Address - Fax:310-675-0120
Practice Address - Street 1:2231 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90018-1302
Practice Address - Country:US
Practice Address - Phone:310-679-3321
Practice Address - Fax:310-675-0120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA273R00000X, 282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
No282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHSM30644FMedicaid