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NPI Code Detail

MEDICARE: DR. SUSAN SCHMIDT-LACKNER M.D.

MEDICARE: DR. SUSAN SCHMIDT-LACKNER M.D.
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
12084P0804XChild & Adolescent Psychiatry PhysicianG48290CA

General Provider Information

NPI Number : 1720129745
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SUSAN SCHMIDT-LACKNER M.D.
Provider Business Mailing Address
First Line : 1239 S CAMDEN DR
Second Line :
City : LOS ANGELES
State : CA
Zip : 90035-1111
Country : US
Telephone Number : 310-836-1223
Fax Number : 310-204-4134
Provider Business Practice Location Address
First Line : 3200 MOTOR AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90034-3710
Country : US
Telephone Number : 310-836-1223
Fax Number : 310-204-4134
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/11/2007
Last Update Date : 07/08/2007

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