Healthcare Provider Details

I. General information

NPI: 1366527954
Provider Name (Legal Business Name): CHILDREN'S HOSPITAL LOS ANGELES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 10/21/2021
Certification Date: 10/21/2021
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: 323-660-2450
  • Fax: 323-666-7816
Mailing address:
  • Phone: 323-660-2450
  • Fax: 323-666-7816

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code281PC2000X
TaxonomyChildren's Chronic Disease Hospital
License Number
License Number StateCA

VIII. Authorized Official

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