Healthcare Provider Details

I. General information

NPI: 1174653646
Provider Name (Legal Business Name): LOPA MALKAN WANI M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5300 MCCONNELL AVE
LOS ANGELES CA
90066-7026
US

IV. Provider business mailing address

5300 MCCONNELL AVE
LOS ANGELES CA
90066-7026
US

V. Phone/Fax

Practice location:
  • Phone: 800-426-6467
  • Fax:
Mailing address:
  • Phone: 800-426-6467
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number93097
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: