Provider Demographics
NPI:1659740264
Name:LOS ANGELES DEPARTMENT OF MEDICAL EXAMINER-CORONER
Entity Type:Organization
Organization Name:LOS ANGELES DEPARTMENT OF MEDICAL EXAMINER-CORONER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN SPECIALIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOB
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:AUGUSTINE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-343-0569
Mailing Address - Street 1:1104 N MISSION RD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033-1017
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1104 N MISSION RD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-1017
Practice Address - Country:US
Practice Address - Phone:323-343-0569
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-24
Last Update Date:2015-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA107596207ZF0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZF0201XAllopathic & Osteopathic PhysiciansPathologyForensic PathologyGroup - Single Specialty