Provider Demographics
NPI:1285981902
Name:LOS ANGELES COUNTY UNIVERSITY OF SOUTHERN CALIFORNIA MEDICAL CENTER
Entity type:Organization
Organization Name:LOS ANGELES COUNTY UNIVERSITY OF SOUTHERN CALIFORNIA MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:HUTTAYASOMBOON
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:626-319-7554
Mailing Address - Street 1:1100 N STATE ST
Mailing Address - Street 2:CLINIC TOWER, A6A231-A
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033-5000
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1100 N STATE ST
Practice Address - Street 2:CLINIC TOWER, A6A231-A
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-5000
Practice Address - Country:US
Practice Address - Phone:323-409-2345
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-13
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21685282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital