Provider Demographics
NPI:1558740852
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:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MURIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:NOUWEZEM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-337-1707
Mailing Address - Street 1:8405 BEVERLY BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-3401
Mailing Address - Country:US
Mailing Address - Phone:323-330-1651
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:323-337-1815
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-20
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0002X, 3336C0003X
CA534303336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy