1023010113 NPI number — SOUTHERN CALIFORNIA HEALTHCARE SYSTEM, INC

Table of content: (NPI 1023010113)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023010113 NPI number — SOUTHERN CALIFORNIA HEALTHCARE SYSTEM, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHERN CALIFORNIA HEALTHCARE SYSTEM, INC
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:
6
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:
1023010113
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/04/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3415 S SEPULVEDA BLVD FL 9
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90034-6060
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-943-4500
Provider Business Mailing Address Fax Number:
310-943-4501

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6245 DE LONGPRE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOLLYWOOD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90028-8253
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-462-2271
Provider Business Practice Location Address Fax Number:
323-463-3830
Provider Enumeration Date:
06/02/2005

Additional Information

Authorized Official

Authorized Official Last Name:
ZILKOW
Authorized Official First Name:
JON
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
310-943-4500

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  930000066 , 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)

  • Identifier: HSP30135I , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: ZZZC9928Z . This is a "BLUE SHEILD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: HSP40135I , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: HSC30135I , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 017840400 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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