Healthcare Provider Details

I. General information

NPI: 1972950665
Provider Name (Legal Business Name): WENDY ANNE CONLON MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2016
Last Update Date: 05/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 UCLA MEDICAL PLZ SUITE 120
LOS ANGELES CA
90095-6956
US

IV. Provider business mailing address

200 MEDICAL PLAZA SUITE 120 UCLA HEALTH
LOS ANGELES CA
90095-6956
US

V. Phone/Fax

Practice location:
  • Phone: 310-825-8711
  • Fax: 310-206-3566
Mailing address:
  • Phone: 310-825-8711
  • Fax: 310-206-3566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License NumberGC000060
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: