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General NPI Number Information
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NPI Number | 1033301221
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Entity Type | Organization
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Legal Business Name | CHILDREN HOSPITAL LOS ANGELES MENTAL HEALTH
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Dates
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Enumeration Date | 08/13/2007
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Last Update Date | 12/05/2025
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Provider Practice Location Address
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Address Line | 3250 WILSHIRE BLVD SUITES 300, 320, 500 & 600
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City | LOS ANGELES
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State | CA
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Zip | 90010-1577
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Country | US
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Telephone | 323-361-3849
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Fax | 323-361-7081
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Provider Business Mailing Address
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Address Line | 3250 WILSHIRE BLVD SUITE 300, 320, 500 & 600
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City | LOS ANGELES
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State | CA
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Zip | 90010-1577
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Country | US
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Telephone | 323-361-3849
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Fax | 323-361-7081
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Authorized Official
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Title or Position | VICE PRESIDENT, QUALITY AND SAFETY
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Name | MARISA GLUCOFT
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Credential |
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Telephone | 323-361-3356
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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