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Organization
61ST MED SQ-LOS ANGELES
Active
Organization
61ST MED SQ-LOS ANGELES
Active
Parent organization
61ST MED SQ-LOS ANGELES
Organization subpart
Yes
Provider details
NPI number
Legal business name
61ST MED SQ-LOS ANGELES
Authorized official
JEN LEWANDOWSKI (DHA UBO)
(703) 817-4030
Entity
Organization
Contact information
Practice address
2420 VELA WAY, SUITE 1866, EL SEGUNDO, CA 90245-4659
(310) 363-6640
(310) 363-0243
Mailing address
2420 VELA WAY, STE 1467, EL SEGUNDO, CA 90245-4659
(310) 653-6437
(310) 653-0243
Taxonomy
Speciality
Code
Description
License number
State
261QM1100X
Military/U.S. Coast Guard Outpatient Clinic/Center
Primary
—
NULL
261QM1101X
Military and U.S. Coast Guard Ambulatory Procedure Clinic/Center
—
NULL
332000000X
Military/U.S. Coast Guard Pharmacy
—
NULL
Other
Enumeration date
12/21/2005
Last updated
06/17/2025
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