Healthcare Provider Details

I. General information

NPI: 1114107414
Provider Name (Legal Business Name): WILLIAM LOFTUS MONRO JR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2007
Last Update Date: 11/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 WILSHIRE BLVD
LOS ANGELES CA
90017-1908
US

IV. Provider business mailing address

PO BOX 48661
LOS ANGELES CA
90048-0661
US

V. Phone/Fax

Practice location:
  • Phone: 213-481-7464
  • Fax:
Mailing address:
  • Phone: 310-909-6692
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: