Provider Demographics
NPI:1124739313
Name:LOS ANGELES COUNTY MIH PC
Entity type:Organization
Organization Name:LOS ANGELES COUNTY MIH PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARI
Authorized Official - Middle Name:
Authorized Official - Last Name:CROGHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:775-745-9239
Mailing Address - Street 1:611 GATEWAY BLVD STE 120
Mailing Address - Street 2:
Mailing Address - City:SOUTH SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94080-7066
Mailing Address - Country:US
Mailing Address - Phone:775-745-9239
Mailing Address - Fax:
Practice Address - Street 1:611 GATEWAY BLVD STE 120
Practice Address - Street 2:
Practice Address - City:SOUTH SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94080-7066
Practice Address - Country:US
Practice Address - Phone:775-745-9239
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-08
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty