Provider Demographics
NPI:1588672042
Name:COUNTY OF LOS ANGELES AUDITOR CONTROLLER
Entity Type:Organization
Organization Name:COUNTY OF LOS ANGELES AUDITOR CONTROLLER
Other - Org Name:SAN FERNANDO HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:RHEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-364-3001
Mailing Address - Street 1:1212 PICO ST
Mailing Address - Street 2:
Mailing Address - City:SAN FERNANDO
Mailing Address - State:CA
Mailing Address - Zip Code:91340-3503
Mailing Address - Country:US
Mailing Address - Phone:818-837-6969
Mailing Address - Fax:
Practice Address - Street 1:1212 PICO ST
Practice Address - Street 2:
Practice Address - City:SAN FERNANDO
Practice Address - State:CA
Practice Address - Zip Code:91340-3503
Practice Address - Country:US
Practice Address - Phone:818-837-6969
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF LOS ANGELES AUDITOR CONTROLLER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-03
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABCP16080FMedicaid