Provider Demographics
NPI:1457437154
Name:CITY OF ANGELS EMERGENCY MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:CITY OF ANGELS EMERGENCY MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:ACOSTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:213-989-6160
Mailing Address - Street 1:PO BOX 800817
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91380-0817
Mailing Address - Country:US
Mailing Address - Phone:661-295-0859
Mailing Address - Fax:661-295-0862
Practice Address - Street 1:1711 W TEMPLE ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90026-5421
Practice Address - Country:US
Practice Address - Phone:213-989-6160
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA25772207PE0004X, 2083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical ServicesGroup - Multi-Specialty
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA25772OtherPRES. STATE LICENSE#
CA00A257720Medicaid
CAGR0088360Medicaid
CA00A257720L72OtherCAL-OPTIMA ID#
CAP00088664OtherRAILROAD MCARE ID#
CAP00088664OtherRAILROAD MCARE ID#
CAA24566Medicare UPIN
CAGR0088360Medicaid