Healthcare Provider Details

I. General information

NPI: 1124073366
Provider Name (Legal Business Name): CHILDRENS HOSPITAL OF LOS ANGELES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 07/20/2022
Certification Date: 07/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4650 W SUNSET BLVD
LOS ANGELES CA
90027-6062
US

IV. Provider business mailing address

4650 W SUNSET BLVD
LOS ANGELES CA
90027-6062
US

V. Phone/Fax

Practice location:
  • Phone: 323-669-2202
  • Fax: 323-668-7951
Mailing address:
  • Phone: 323-669-2202
  • Fax: 323-668-7951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code282NC2000X
TaxonomyChildren's Hospital
License Number930000032
License Number StateCA

VIII. Authorized Official

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