Provider Demographics
NPI:1912372475
Name:LOS ANGELES COUNTY HOSPITAL OF UNIVERSITY OF SOURTHERN CALIFORNIA (LAC
Entity Type:Organization
Organization Name:LOS ANGELES COUNTY HOSPITAL OF UNIVERSITY OF SOURTHERN CALIFORNIA (LAC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESIDENCY SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ARNWINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-226-6937
Mailing Address - Street 1:4350 LOWELL AVE
Mailing Address - Street 2:
Mailing Address - City:LA CRESCENTA
Mailing Address - State:CA
Mailing Address - Zip Code:91214-2363
Mailing Address - Country:US
Mailing Address - Phone:616-560-4326
Mailing Address - Fax:
Practice Address - Street 1:4350 LOWELL AVE
Practice Address - Street 2:
Practice Address - City:LA CRESCENTA
Practice Address - State:CA
Practice Address - Zip Code:91214-2363
Practice Address - Country:US
Practice Address - Phone:616-560-4326
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-09
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA139573207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty