Provider Demographics
NPI:1689687345
Name:COUNTY OF LOS ANGELES AUDITOR CONTROLLER
Entity Type:Organization
Organization Name:COUNTY OF LOS ANGELES AUDITOR CONTROLLER
Other - Org Name:LA PUENTE SUB CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INTERIM CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:CORBET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-226-2400
Mailing Address - Street 1:15930 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:LA PUENTE
Mailing Address - State:CA
Mailing Address - Zip Code:91744-5410
Mailing Address - Country:US
Mailing Address - Phone:626-579-8302
Mailing Address - Fax:
Practice Address - Street 1:15930 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:LA PUENTE
Practice Address - State:CA
Practice Address - Zip Code:91744-5410
Practice Address - Country:US
Practice Address - Phone:626-579-8302
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF LOS ANGELES AUDITOR CONTROLLER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-14
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHAP16100FMedicaid