MEDICARE: DR. LAURA WACHSMAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	G34368	CA

General Provider Information

NPI Number	:	1356496012
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAURA WACHSMAN

Provider Business Mailing Address
First Line	:	1200 N STATE ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90033-1029
Country	:	US
Telephone Number	:	323-226-2170
Fax Number	:	323-226-5760

Provider Business Practice Location Address
First Line	:	1240 N MISSION RD
Second Line	:	WOMEN'S AND CHILDREN'S HOSPITAL L-902
City	:	LOS ANGELES
State	:	CA
Zip	:	90033-1019
Country	:	US
Telephone Number	:	323-226-3691
Fax Number	:	323-226-5692

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/24/2007
Last Update Date	:	07/08/2007

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