Provider Demographics
NPI:1982615274
Name:COUNTY OF LOS ANGELES
Entity Type:Organization
Organization Name:COUNTY OF LOS ANGELES
Other - Org Name:LA PUENTE SUB CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INTERIM CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:CORBET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-226-2400
Mailing Address - Street 1:15930 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:LA PUENTE
Mailing Address - State:CA
Mailing Address - Zip Code:91744-5410
Mailing Address - Country:US
Mailing Address - Phone:626-579-8302
Mailing Address - Fax:
Practice Address - Street 1:15930 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:LA PUENTE
Practice Address - State:CA
Practice Address - Zip Code:91744-5410
Practice Address - Country:US
Practice Address - Phone:626-579-8302
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF LOS ANGELES AUDITOR
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-11
Last Update Date:2018-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW932Medicare ID - Type UnspecifiedLP HC MEDICARE OP