Provider Demographics
NPI:1801030804
Name:LAC USC
Entity Type:Organization
Organization Name:LAC USC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RON
Authorized Official - Middle Name:
Authorized Official - Last Name:BEN -ARI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-226-7556
Mailing Address - Street 1:18417 JEFFREY AVE
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-6150
Mailing Address - Country:US
Mailing Address - Phone:562-402-0727
Mailing Address - Fax:
Practice Address - Street 1:2020 ZONAL AVE
Practice Address - Street 2:IRD BUILDING,INTERNAL MEDICINE DEPARTMENT
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90089-0121
Practice Address - Country:US
Practice Address - Phone:323-226-7556
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-22
Last Update Date:2009-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA105552261QP2300X, 282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care