MEDICARE: WOMEN AND CHILDREN'S CLINIC OF LITTLE COMPANY OF MARY

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	207VM0101X	Maternal & Fetal Medicine Physician		CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548487143
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WOMEN AND CHILDREN'S CLINIC OF LITTLE COMPANY OF MARY

Provider Business Mailing Address
First Line	:	1403 LOMITA BLVD
Second Line	:	STE 100
City	:	HARBOR CITY
State	:	CA
Zip	:	90710-2076
Country	:	US
Telephone Number	:	310-784-5800
Fax Number	:	310-530-9811

Provider Business Practice Location Address
First Line	:	1403 LOMITA BLVD
Second Line	:	STE 100
City	:	HARBOR CITY
State	:	CA
Zip	:	90710-2076
Country	:	US
Telephone Number	:	310-784-5800
Fax Number	:	310-530-9811

Authorized Official
Title or Position	:	CHIEF OPERATING OFFICER
Name	:	FRANCESCA F WACHS
Credential	:
Telephone Number	:	310-793-8074

Provider Enumeration Date	:	04/18/2007
Last Update Date	:	08/22/2020

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