MEDICARE: CHILDREN'S HOSPITAL LOS ANGELES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	MFC43890	CA

General Provider Information

NPI Number	:	1255455242
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHILDREN'S HOSPITAL LOS ANGELES

Provider Business Mailing Address
First Line	:	8455 FOUNTAIN AVE
Second Line	:	#628
City	:	WEST HOLLYWOOD
State	:	CA
Zip	:	90069-2536
Country	:	US
Telephone Number	:	310-266-2382
Fax Number	:

Provider Business Practice Location Address
First Line	:	3250 WILSHIRE BLVD
Second Line	:	5TH FLOOR
City	:	LOS ANGELES
State	:	CA
Zip	:	90010-1577
Country	:	US
Telephone Number	:	323-671-3849
Fax Number	:

Authorized Official
Title or Position	:	SR.VP/CFO
Name	:	MR. MAX SCOTT LIEBERENZ
Credential	:	CPA
Telephone Number	:	323-361-2235

Provider Enumeration Date	:	03/17/2007
Last Update Date	:	10/21/2021

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Directions to “CHILDREN'S HOSPITAL LOS ANGELES ” Practice Location

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