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General NPI Number Information
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NPI Number | 1770607095
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Entity Type | Organization
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Legal Business Name | CHILDREN'S HOSPITAL LOS ANGELES
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Dates
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Enumeration Date | 03/19/2007
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Last Update Date | 10/21/2021
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Provider Practice Location Address
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Address Line | 711 N AVENUE 53
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City | LOS ANGELES
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State | CA
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Zip | 90042-2413
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Country | US
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Telephone | 323-349-0578
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Fax |
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Provider Business Mailing Address
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Address Line | 711 N AVENUE 53
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City | LOS ANGELES
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State | CA
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Zip | 90042-2413
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Country | US
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Telephone | 323-349-0578
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Fax |
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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 | 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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