Provider Demographics
NPI:1639353170
Name:PUBLIC GUADIAN OFFICE
Entity Type:Organization
Organization Name:PUBLIC GUADIAN OFFICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DPC/A I
Authorized Official - Prefix:MR
Authorized Official - First Name:MALIK
Authorized Official - Middle Name:MAULANA
Authorized Official - Last Name:RAHH
Authorized Official - Suffix:
Authorized Official - Credentials:DPG
Authorized Official - Phone:213-974-7105
Mailing Address - Street 1:320 W TEMPLE ST FL 9
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90012-3217
Mailing Address - Country:US
Mailing Address - Phone:213-974-7105
Mailing Address - Fax:213-620-1405
Practice Address - Street 1:320 W TEMPLE ST FL 9
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90012-3217
Practice Address - Country:US
Practice Address - Phone:213-974-7105
Practice Address - Fax:213-620-1405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-19
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility