Healthcare Provider Details

I. General information

NPI: 1871856583
Provider Name (Legal Business Name): ERIC AHLERS SCHLUEDERBERG D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2012
Last Update Date: 07/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3727 W 6TH ST SUITE 200
LOS ANGELES CA
90020-5105
US

IV. Provider business mailing address

3727 W 6TH ST SUITE 200
LOS ANGELES CA
90020-5105
US

V. Phone/Fax

Practice location:
  • Phone: 213-235-2500
  • Fax: 213-251-8647
Mailing address:
  • Phone: 213-235-2500
  • Fax: 213-251-8647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A12994
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: