Organization
CONCENTRA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. OLIVIA HERNANDEZ (CREDENTIALING SPECIALIST)
(972) 364-8253
Entity
Organization
Contact information
Practice address
6033 W CENTURY BLVD, LOS ANGELES, CA 90045-6410
(310) 258-0684
Mailing address
6033 W CENTURY BLVD, LOS ANGELES, CA 90045-6410
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
43478
CA
Other
Enumeration date
12/30/2015
Last updated
12/30/2015
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