Healthcare Provider Details

I. General information

NPI: 1427627884
Provider Name (Legal Business Name): WILTON HAVEN CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2021
Last Update Date: 03/22/2022
Certification Date: 03/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 S WILTON PL
LOS ANGELES CA
90019-2127
US

IV. Provider business mailing address

909 S WILTON PL
LOS ANGELES CA
90019-2127
US

V. Phone/Fax

Practice location:
  • Phone: 323-737-1844
  • Fax: 323-737-7555
Mailing address:
  • Phone: 323-737-1844
  • Fax: 323-737-7555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code177F00000X
TaxonomyLodging Provider
License Number
License Number State

VIII. Authorized Official

Name: MARIA M BARRIOS
Title or Position: CEO
Credential:
Phone: 323-974-8631