1215960984 NPI number — GREATER LOS ANGELES HEALTH CARE SYSTEM

Table of content: (NPI 1215960984)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215960984 NPI number — GREATER LOS ANGELES HEALTH CARE SYSTEM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GREATER LOS ANGELES HEALTH CARE SYSTEM
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:
1215960984
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16820 EDGAR ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PACIFIC PALISADES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90272-3227
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-478-3711
Provider Business Mailing Address Fax Number:
310-268-4086

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11301 WILSHIRE BLVD
Provider Second Line Business Practice Location Address:
BLDG 500 ROOM # 3209
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90073-1003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-478-3711
Provider Business Practice Location Address Fax Number:
310-268-4086
Provider Enumeration Date:
07/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BATUMAN
Authorized Official First Name:
FATMA
Authorized Official Middle Name:
KHAWAJA
Authorized Official Title or Position:
DIRECTOR, WOMEN'S HEALTH CLINIC
Authorized Official Telephone Number:
310-478-3711

Provider Taxonomy Codes

  • Taxonomy code: 282NW0100X , with the licence number:  C51537 , 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)





Copyright © 2007-2025 www.npivalidator.com