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General NPI Number Information
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NPI Number | 1477803450
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Entity Type | Organization
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Legal Business Name | CHILDRENS HOSPITAL OF LOS ANGELES
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Dates
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Enumeration Date | 09/17/2012
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Last Update Date | 10/21/2021
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Provider Practice Location Address
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Address Line | 4650 W SUNSET BLVD # 61
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City | LOS ANGELES
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State | CA
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Zip | 90027-6062
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Country | US
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Telephone | 323-361-8705
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Fax | 323-361-8065
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Provider Business Mailing Address
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Address Line | 4650 W SUNSET BLVD # 61
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City | LOS ANGELES
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State | CA
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Zip | 90027-6062
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Country | US
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Telephone | 323-361-8705
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Fax | 323-361-8065
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Authorized Official
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Title or Position | SR.VP/CFO
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Name | MR. MAX SCOTT LIEBERENZ
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Credential | CPA
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Telephone | 323-361-2235
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 20A11202
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License Number State | CA
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