Provider Demographics
NPI:1255795258
Name:LOS ANGELES PIERCE COLLEGE
Entity type:Organization
Organization Name:LOS ANGELES PIERCE COLLEGE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, STUDENT HEALTH CENTER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:A
Authorized Official - Last Name:BENNE
Authorized Official - Suffix:
Authorized Official - Credentials:RN,PHN, MA
Authorized Official - Phone:818-710-4270
Mailing Address - Street 1:6201 WINNETKA AVE
Mailing Address - Street 2:STUDENT HEALTH CENTER
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91371-0001
Mailing Address - Country:US
Mailing Address - Phone:818-710-4270
Mailing Address - Fax:
Practice Address - Street 1:6201 WINNETKA AVE
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91371-0001
Practice Address - Country:US
Practice Address - Phone:818-710-4270
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LOS ANGELES COMMUNITY COLLEGE DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-04-06
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health
No251300000XAgenciesLocal Education Agency (LEA)