Provider Demographics
NPI:1679061592
Name:COUNTY OF LOS ANGELES
Entity Type:Organization
Organization Name:COUNTY OF LOS ANGELES
Other - Org Name:EAST LOS ANGELES HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROYBAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-362-1400
Mailing Address - Street 1:5555 FERGUSON DR
Mailing Address - Street 2:
Mailing Address - City:COMMERCE
Mailing Address - State:CA
Mailing Address - Zip Code:90022-5164
Mailing Address - Country:US
Mailing Address - Phone:323-914-7365
Mailing Address - Fax:
Practice Address - Street 1:133 N SUNOL DR
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90063-1429
Practice Address - Country:US
Practice Address - Phone:323-260-2801
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF LOS ANGELES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-04-26
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care