Healthcare Provider Details

I. General information

NPI: 1255582839
Provider Name (Legal Business Name): RACHA TAHANI LAWLER LM, CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2008
Last Update Date: 04/20/2022
Certification Date: 04/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2422 W FLORENCE AVE
LOS ANGELES CA
90043-5105
US

IV. Provider business mailing address

1976 S LA CIENEGA BLVD # C-762
LOS ANGELES CA
90034-1627
US

V. Phone/Fax

Practice location:
  • Phone: 323-541-9100
  • Fax: 310-541-9191
Mailing address:
  • Phone: 323-404-4022
  • Fax: 310-541-9191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberLM231
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: