Provider Demographics
NPI:1770718348
Name:EL MONTE CITY SHOOL DISTRICT
Entity type:Organization
Organization Name:EL MONTE CITY SHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:LY
Authorized Official - Middle Name:KIM
Authorized Official - Last Name:KOUCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-453-3700
Mailing Address - Street 1:3540 LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91731-2608
Mailing Address - Country:US
Mailing Address - Phone:626-453-3700
Mailing Address - Fax:
Practice Address - Street 1:3540 LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91731-2608
Practice Address - Country:US
Practice Address - Phone:626-453-3700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-26
Last Update Date:2009-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA540660261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service