Provider Demographics
NPI:1053437483
Name:ST. FRANCIS MEDICAL CENTER - CCC
Entity type:Organization
Organization Name:ST. FRANCIS MEDICAL CENTER - CCC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:
Authorized Official - Last Name:KOZAI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-900-7301
Mailing Address - Street 1:3630 E IMPERIAL HWY
Mailing Address - Street 2:
Mailing Address - City:LYNWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90262-2609
Mailing Address - Country:US
Mailing Address - Phone:310-900-8490
Mailing Address - Fax:310-632-6732
Practice Address - Street 1:4390 TWEEDY BLVD
Practice Address - Street 2:
Practice Address - City:SOUTH GATE
Practice Address - State:CA
Practice Address - Zip Code:90280-6237
Practice Address - Country:US
Practice Address - Phone:310-609-6949
Practice Address - Fax:323-583-6879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA93000157261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health