1801030804 NPI number — LAC USC

Table of content: (NPI 1801030804)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801030804 NPI number — LAC USC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LAC USC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1801030804
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/22/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18417 JEFFREY AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CERRITOS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90703-6150
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
562-402-0727
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2020 ZONAL AVE
Provider Second Line Business Practice Location Address:
IRD BUILDING,INTERNAL MEDICINE DEPARTMENT
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90089-0121
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-226-7556
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/22/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BEN -ARI
Authorized Official First Name:
RON
Authorized Official Middle Name:
Authorized Official Title or Position:
PROGRAM DIRECTOR
Authorized Official Telephone Number:
323-226-7556

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X , with the licence number:  A105552 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282N00000X , with the licence number: A105552 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)