1538376298 NPI number — LAX HEALTH CARE TECHNOLGY

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 1538376298 NPI number — LAX HEALTH CARE TECHNOLGY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LAX HEALTH CARE TECHNOLGY
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:
1538376298
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/06/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8939 S SEPULVEDA BLVD
Provider Second Line Business Mailing Address:
SUITE 424
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90045-3631
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-410-9907
Provider Business Mailing Address Fax Number:
310-410-9387

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8939 S SEPULVEDA BLVD
Provider Second Line Business Practice Location Address:
SUITE 424
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90045-3631
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-410-9907
Provider Business Practice Location Address Fax Number:
310-410-9387
Provider Enumeration Date:
05/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
OGWONUWE
Authorized Official First Name:
CHRIS
Authorized Official Middle Name:
NGOZI
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
310-738-0387

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  46844 , 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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