1255669339 NPI number — LOS ANGELES COUNTY, UNIVERSITY OF SOUTHERN CALIFORNIA HOSPITAL

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255669339 NPI number — LOS ANGELES COUNTY, UNIVERSITY OF SOUTHERN CALIFORNIA HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LOS ANGELES COUNTY, UNIVERSITY OF SOUTHERN CALIFORNIA HOSPITAL
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:
LAC USC HOSPITAL
Provider Other Organization Name Type Code:
5
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:
1255669339
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/30/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1200 N STATE ST RM 1011
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:
90033-1029
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
323-226-6667
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1200 N STATE ST RM 1011
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90033-1029
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-226-6667
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/30/2009

Additional Information

Authorized Official

Authorized Official Last Name:
GOLDBERG
Authorized Official First Name:
ANDREW
Authorized Official Middle Name:
DANIEL
Authorized Official Title or Position:
POST GRADUATE PHYSICIAN
Authorized Official Telephone Number:
323-226-6667

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  A107694 , 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)





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