DEPARTMENT OF HEALTH SERVICES

NPI # 

Practice Address:

450 Bauchet St , Msb ----Room E873

Los Angeles, CA, 90012-2907

Practice Phone:

323-568-4550

License Number:

14185

License State:

CA

Taxonomy Grouping:

Ambulatory Health Care Facilities

Taxonomy Classification:

Clinic/Center

Taxonomy Specialization:

Prison Health

Taxonomy Code:

261QP2400X