Healthcare Provider Details

I. General information

NPI: 1114964228
Provider Name (Legal Business Name): CARLOS F LERNER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 08/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

GENERAL PEDIATRICS 12 466 MDCC 10833 LE CONTE AVE
LOS ANGELES CA
90095-0001
US

IV. Provider business mailing address

GENERAL PEDIATRICS 12 466 MDCC 10833 LE CONTE AVE
LOS ANGELES CA
90095-0001
US

V. Phone/Fax

Practice location:
  • Phone: 310-794-2163
  • Fax: 310-206-4855
Mailing address:
  • Phone: 310-794-2163
  • Fax: 310-206-4855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA98508
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: