MARTIN LUTHER KINGJR-MULTI-SERVICE AMBULATORY CARE CENTER


Address: 12021 South Wilmington Ave, Los Angeles, CA 90059
Phone: 3106683972

MARTIN LUTHER KINGJR-MULTI-SERVICE AMBULATORY CARE CENTER (NPI# 1770797805) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1770797805
Entity Type Organization
Organization Name MARTIN LUTHER KINGJR-MULTI-SERVICE AMBULATORY CARE CENTER
Practice Address 12021 South Wilmington Ave
Los Angeles
CA 90059
Practice Telephone 3106683972
Practice Fax Number 3106872960
Enumeration Date 2007-05-09
Last Update Date 2009-03-12
Authorized Official Name MS. CAROLYN S. CLARK (ADMINISTRATOR)
Authorized Official Telephone 3106685201
Is Organization Subpart N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 3336C0002X Pharmacy
Specialization: Clinic Pharmacy
PHE14222 CA Suppliers

Office Location

Street Address 12021 SOUTH WILMINGTON AVE
City LOS ANGELES
State CA
Zip Code 90059

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NPI Name Taxonomy Address Enumeration
1235759788 Juan Jimenez Jr. Technician, Pathology 1860 E 120th St, Los Angeles, CA 90059 2020-04-24
1538717780 Donald O Nwanze Pharmacist Mlk Outpatient Center (pharmacy), 1670 East 120th Street, Los Angeles, CA 90059 2019-08-30
1295391050 Sheela Hoyle Counselor 836 East Saucer Lane, Los Angeles, CA 90059 2019-05-16
1750852471 Carlos Tovar Sr. Community Health Worker 1720 E 120st, Los Angeles, CA 90059 2018-12-06
1699293910 Amy Caryn Bolenbaugh Recreation Therapist 1720 E 120th Street, Los Angeles, CA 90059 2017-09-07
1417475757 Scott Lee Jones Recreation Therapist Augustus F. Hawkins, 1720 E. 120th Street, Rm. 2196, Los Angeles, CA 90059 2017-09-07
1881118859 Darlene Renee Tillman Speech-Language Pathologist 1670 E 120th Strret, Los Angeles, CA 90059 2017-08-01
1609306430 Valda Therese Flores Registered Nurse 1670 E. 120th Street, Los Angeles, CA 90059 2017-06-14
1093244006 Bongsill Chung Registered Nurse 1670 East 120th St, Los Angeles, CA 90059 2017-06-05
1730573395 Apollonia Godoy Registered Nurse 1670 E. 120th St, 4th Floor, Module A, Los Angeles, CA 90059 2015-03-22
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Taxonomy Information

Taxonomy Code 3336C0002X
Grouping Suppliers
Classification Pharmacy
Specialization Clinic Pharmacy

Taxonomy Definition

A pharmacy in a clinic, emergency room or hospital (outpatient) that dispenses medications to patients for self-administration under the supervision of a pharmacist.
Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new]

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1306263264 University of Southern California Pharmacy 830 S Flower St, Los Angeles, CA 90017-4608 2014-03-27
1396867578 County of Los Angeles - Auditor Controller Pharmacy 5850 S. Main St, Los Angeles, CA 90003-1215 2007-04-06
1649303306 Women's & Children's Hospital Pharmacy Pharmacy 1240 N Mission Rd Trlr 7b, Los Angeles, CA 90033-1019 2007-03-13
1821146622 Kaiser Foundation Health Plan Inc Pharmacy 1526 N Edgemont St Fl 1, Los Angeles, CA 90027-5260 2007-01-08
1033131107 Aids Healthcare Foundation Pharmacy 1400 S Grand Ave Ste 801, Los Angeles, CA 90015-3068 2006-07-24
1215575873 Lauren Andrea Tuason Pharmacy 1670 E 120th St, Los Angeles, CA 90059-3026 2019-12-13
1710437231 San Vincente Women's Total Health Center Inc Pharmacy 6310 San Vicente Blvd, Suite 220, Los Angeles, CA 90048-5426 2016-10-07
1902355647 East La Paz Family Medical Clinic Pa Pharmacy 3712 Whittier Blvd, Suite 1, Los Angeles, CA 90023-1733 2016-09-22
1558740852 The Los Angeles Free Clinic Pharmacy 5205 Melrose Ave, Los Angeles, CA 90038-3144 2015-05-20
1063822872 Anthony Martin Mills, M.d., Pharmacy Inc. Pharmacy 9201 W Sunset Blvd Ste 812, Los Angeles, CA 90069-3709 2014-05-01
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Competitor

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City LOS ANGELES
Zip Code 90059

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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