Healthcare Provider Details

I. General information

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

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1403 LOMITA BLVD STE 100
HARBOR CITY CA
90710-2076
US

IV. Provider business mailing address

1403 LOMITA BLVD STE 100
HARBOR CITY CA
90710-2076
US

V. Phone/Fax

Practice location:
  • Phone: 310-784-5800
  • Fax: 310-530-9811
Mailing address:
  • Phone: 310-784-5800
  • Fax: 310-530-9811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number
License Number StateCA

VIII. Authorized Official

Name: FRANCESCA F WACHS
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 310-793-8074