=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861643900
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LAUREN SWERDLOFF, MD A MEDICAL PROFESSIONAL CORP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/07/2008
-----------------------------------------------------
Last Update Date | 02/18/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1821 WILSHIRE BLVD STE 220
-----------------------------------------------------
City | SANTA MONICA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90403-5627
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-829-5189
-----------------------------------------------------
Fax | 310-829-5942
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1821 WILSHIRE BLVD STE 220
-----------------------------------------------------
City | SANTA MONICA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90403-5627
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-829-5189
-----------------------------------------------------
Fax | 310-829-5942
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | LAUREN CIEL SWERDLOFF
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 310-829-5189
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM2500X
-----------------------------------------------------
Taxonomy Name | Medical Specialty Clinic/Center
-----------------------------------------------------
License Number | G67752
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------