Provider Demographics
NPI:1801160296
Name:COUNTY OF LOS ANGELES
Entity type:Organization
Organization Name:COUNTY OF LOS ANGELES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MED PEDS PROGRAM DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRECK
Authorized Official - Middle Name:
Authorized Official - Last Name:NICHOLS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-226-5610
Mailing Address - Street 1:9314 OLYMPIC BLVD
Mailing Address - Street 2:
Mailing Address - City:PICO RIVERA
Mailing Address - State:CA
Mailing Address - Zip Code:90660-2142
Mailing Address - Country:US
Mailing Address - Phone:562-443-8904
Mailing Address - Fax:
Practice Address - Street 1:2020 ZONAL AVE RM 115
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90089-0121
Practice Address - Country:US
Practice Address - Phone:323-226-5610
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-02
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA120119282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital