=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154577948
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CARLA E. HERRIFORD, M.D., APC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/12/2008
-----------------------------------------------------
Last Update Date | 11/02/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4071 PUNTA ALTA DR
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90008-1130
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-339-2979
-----------------------------------------------------
Fax | 310-339-2979
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12021 WILMINGTON AVE
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90059-3019
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-668-5172
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DR. CARLA ELAINE HERRIFORD
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 310-339-2979
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | C40031
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------