Healthcare Provider Details

I. General information

NPI: 1609368471
Provider Name (Legal Business Name): CHILDREN'S HEALTH ALLIANCE OF MEDICAL PROVIDERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2018
Last Update Date: 06/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4601 W SUNSET BLVD
LOS ANGELES CA
90027-6020
US

IV. Provider business mailing address

4601 W SUNSET BLVD
LOS ANGELES CA
90027-6020
US

V. Phone/Fax

Practice location:
  • Phone: 323-361-6449
  • Fax:
Mailing address:
  • Phone: 323-361-6449
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. CYNTHIA GODINEZ
Title or Position: SR. FINANCIAL ANALYST
Credential:
Phone: 323-361-6449