Provider Demographics
NPI:1104957489
Name:COUNTY OF LOS ANGELES DMH
Entity type:Organization
Organization Name:COUNTY OF LOS ANGELES DMH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF DMH
Authorized Official - Prefix:DR
Authorized Official - First Name:MARVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SOUTHER
Authorized Official - Suffix:
Authorized Official - Credentials:DSW
Authorized Official - Phone:213-738-4651
Mailing Address - Street 1:1401 W MAGNOLIA ST
Mailing Address - Street 2:
Mailing Address - City:COMPTON
Mailing Address - State:CA
Mailing Address - Zip Code:90220-1501
Mailing Address - Country:US
Mailing Address - Phone:310-594-1332
Mailing Address - Fax:
Practice Address - Street 1:921 E COMPTON BLVD
Practice Address - Street 2:
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90221-3303
Practice Address - Country:US
Practice Address - Phone:310-668-6855
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS21312251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1041C0700XMedicaid