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General NPI Number Information
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NPI Number | 1538562863
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Entity Type | Organization
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Legal Business Name | SMILE PEDIATRIC THERAPY & DIAGNOSTICS
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Dates
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Enumeration Date | 10/01/2014
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Last Update Date | 10/01/2014
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Provider Practice Location Address
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Address Line | 5000 W SUNSET BLVD SUITE 510
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City | LOS ANGELES
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State | CA
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Zip | 90027-5861
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Country | US
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Telephone | 323-644-9380
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Fax | 323-644-9381
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Provider Business Mailing Address
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Address Line | 5000 W SUNSET BLVD SUITE 510
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City | LOS ANGELES
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State | CA
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Zip | 90027-5861
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Country | US
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Telephone | 323-644-9380
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Fax | 323-644-9381
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Authorized Official
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Title or Position | CEO
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Name | MRS. NICOLE HAJJAR
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Credential |
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Telephone | 323-644-9380
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0700X
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Taxonomy Name | Hearing and Speech Clinic/Center
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License Number | 22261
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License Number State | CA
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