Provider Demographics
NPI:1922397736
Name:LAC USC MEDICAL CENTER
Entity Type:Organization
Organization Name:LAC USC MEDICAL CENTER
Other - Org Name:GENERAL HOSPITAL
Other - Org Type:Other Name
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MR
Authorized Official - First Name:MAXIMIANO
Authorized Official - Middle Name:
Authorized Official - Last Name:VILLALPANDO
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:323-253-9743
Mailing Address - Street 1:1334 LOTTA DR.
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90063
Mailing Address - Country:US
Mailing Address - Phone:323-253-9743
Mailing Address - Fax:
Practice Address - Street 1:1334 LOTTA DR.
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90063
Practice Address - Country:US
Practice Address - Phone:323-253-9743
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-01
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20273282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital