Provider Demographics
NPI:1639354301
Name:LAC/USC MEDICAL CENTER
Entity Type:Organization
Organization Name:LAC/USC MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CAMERON
Authorized Official - Middle Name:
Authorized Official - Last Name:MANBEIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-226-7257
Mailing Address - Street 1:1201 NORTH STATE ST.
Mailing Address - Street 2:3550
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1201 NORTH STATE STREET
Practice Address - Street 2:3550
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-0000
Practice Address - Country:US
Practice Address - Phone:323-226-7257
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-31
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA98135282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital