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General NPI Number Information
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NPI Number | 1508154188
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Entity Type | Individual
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Provider Name | TARA LEANNE SEDLAK MD
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Gender | Female
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Dates
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Enumeration Date | 07/15/2011
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Last Update Date | 07/15/2011
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Provider Practice Location Address
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Address Line | 444 S SAN VICENTE BLVD STE 600
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City | LOS ANGELES
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State | CA
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Zip | 90048-4174
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Country | US
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Telephone | 310-423-9979
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Fax |
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Provider Business Mailing Address
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Address Line | 5700 W 6TH ST APT 422
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City | LOS ANGELES
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State | CA
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Zip | 90036-5820
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Country | US
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Telephone | 310-691-9563
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | A117536
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License Number State | CA
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