Provider Demographics
NPI:1942477757
Name:LOS ANGELES SHERIFF'S DEPARTMENT
Entity Type:Organization
Organization Name:LOS ANGELES SHERIFF'S DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:OFELIA
Authorized Official - Last Name:CRUZ DE PORTILLO
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:213-893-5455
Mailing Address - Street 1:19400 LANARK ST
Mailing Address - Street 2:
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-1013
Mailing Address - Country:US
Mailing Address - Phone:818-885-0864
Mailing Address - Fax:818-885-0864
Practice Address - Street 1:450 BAUCHET ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90012-2907
Practice Address - Country:US
Practice Address - Phone:213-893-5455
Practice Address - Fax:213-633-4663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-12
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA586319 NPC16628302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization