Provider Demographics
NPI:1144668336
Name:HUBERT H. HUMPHREY COMPREHENSIVE HEALTH CENTER
Entity type:Organization
Organization Name:HUBERT H. HUMPHREY COMPREHENSIVE HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LAKSHMI
Authorized Official - Middle Name:
Authorized Official - Last Name:MAKAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-846-4104
Mailing Address - Street 1:5850 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90003-1215
Mailing Address - Country:US
Mailing Address - Phone:323-846-4104
Mailing Address - Fax:
Practice Address - Street 1:1000 S FREMONT AVE BLDG A-9A
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91803-8800
Practice Address - Country:US
Practice Address - Phone:626-299-3366
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LOS ANGELES COUNTY DEPARTMENT OF HEALTH SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-06-10
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA30975261QP2300X, 261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care