| Lake Los Angeles Community Clinic | |
|
16921 E Avenue O Ste G Palmdale CA 93591-3045 | |
| (661) 945-8444 | |
| Not Available |
| Full Name | Lake Los Angeles Community Clinic |
|---|---|
| Speciality | Clinic/center |
| Location | 16921 E Avenue O Ste G, Palmdale, California |
| Authorized Official Name and Position | Beryl Brooks (CLINIC ADMINISTRATOR) |
| Authorized Official Contact | 6614714200 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lake Los Angeles Community Clinic 16921 E Avenue O Ste G Palmdale CA 93591-3045 Ph: (661) 945-8444 | Lake Los Angeles Community Clinic 16921 E Avenue O Ste G Palmdale CA 93591-3045 Ph: (661) 945-8444 |
| NPI Number | 1982919528 |
|---|---|
| Provider Enumeration Date | 08/06/2010 |
| Last Update Date | 03/05/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982919528 | NPI | - | NPPES |
| HAP16012F | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
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