Provider Demographics
NPI:1558608554
Name:COUNTY OF LOS ANGELES
Entity Type:Organization
Organization Name:COUNTY OF LOS ANGELES
Other - Org Name:LAC HARBOR UCLA MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:ROSITA
Authorized Official - Middle Name:
Authorized Official - Last Name:BANUELOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:424-306-7501
Mailing Address - Street 1:1000 W CARSON ST
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90502-2004
Mailing Address - Country:US
Mailing Address - Phone:424-306-6580
Mailing Address - Fax:
Practice Address - Street 1:1000 W CARSON ST
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90502-2004
Practice Address - Country:US
Practice Address - Phone:424-306-6580
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF LOS ANGELES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-01-10
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60000129282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHAP40376FMedicaid