Provider Demographics
NPI:1629567060
Name:DTLA MED
Entity Type:Organization
Organization Name:DTLA MED
Other - Org Name:DTLA MED
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALI
Authorized Official - Middle Name:
Authorized Official - Last Name:BADDAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-677-0677
Mailing Address - Street 1:431 S HEWITT ST STE B
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90013-2215
Mailing Address - Country:US
Mailing Address - Phone:949-677-0677
Mailing Address - Fax:
Practice Address - Street 1:431 S HEWITT ST STE B
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90013
Practice Address - Country:US
Practice Address - Phone:949-677-0677
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-01
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty