Provider Demographics
NPI:1942281936
Name:WHITE MEMORIAL MEDICAL CENTER
Entity Type:Organization
Organization Name:WHITE MEMORIAL MEDICAL CENTER
Other - Org Name:ADVENTIST HEALTH WHITE MEMORIAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:RAFFOUL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-268-5000
Mailing Address - Street 1:1720 E CESAR E CHAVEZ AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033-2414
Mailing Address - Country:US
Mailing Address - Phone:323-268-5000
Mailing Address - Fax:323-265-5070
Practice Address - Street 1:1720 E CESAR E CHAVEZ AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-2414
Practice Address - Country:US
Practice Address - Phone:323-268-5000
Practice Address - Fax:323-265-5070
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WHITE MEMORIAL MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-11-08
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA930000195284300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes284300000XHospitalsSpecial Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALTC55312FMedicaid
CAZZZA1920ZOtherBLUE SHIELD
CALTC55312FMedicaid
CA555312Medicare Oscar/Certification