Provider Demographics
NPI:1649086166
Name:THE WALL LAS MEMORIAS
Entity type:Organization
Organization Name:THE WALL LAS MEMORIAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR/FOUNDER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:L
Authorized Official - Last Name:ZALDIVAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-257-1056
Mailing Address - Street 1:800 W 6TH ST STE 750
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90017-2747
Mailing Address - Country:US
Mailing Address - Phone:323-257-1056
Mailing Address - Fax:323-529-0200
Practice Address - Street 1:2020 E 1ST ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-3916
Practice Address - Country:US
Practice Address - Phone:323-257-1056
Practice Address - Fax:323-529-0200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-09
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health