Healthcare Provider Details

I. General information

NPI: 1467748145
Provider Name (Legal Business Name): BARBARA RUNIA RN , CWON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2011
Last Update Date: 06/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 WESTWOOD BLVD SUITE # 2D
LA CA
90025
US

IV. Provider business mailing address

1700 WESTWOOD BLVD SUITE # 2D C/O BABAK ROOZROKH MD
LA CA
90025
US

V. Phone/Fax

Practice location:
  • Phone: 310-230-7400
  • Fax:
Mailing address:
  • Phone: 310-230-7400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number272695
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number2002211227
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code163WX1500X
TaxonomyOstomy Care Registered Nurse
License Number2002211227
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: