Provider Demographics
NPI:1932080975
Name:MANCHESTER COMMUNITY MEDICAL CENTER
Entity type:Organization
Organization Name:MANCHESTER COMMUNITY MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:OLUKEMI
Authorized Official - Middle Name:
Authorized Official - Last Name:WALLACE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-644-8400
Mailing Address - Street 1:2220 W MANCHESTER BLVD
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90305-2514
Mailing Address - Country:US
Mailing Address - Phone:310-644-8400
Mailing Address - Fax:310-644-8424
Practice Address - Street 1:2220 W MANCHESTER BLVD
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90305-2514
Practice Address - Country:US
Practice Address - Phone:310-644-8400
Practice Address - Fax:310-644-8424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-08
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty