MEDICARE: SHULI LEAH LOTAN MSW, PPSC

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	1041S0200X	School Social Worker	24071	CA

General Provider Information

NPI Number	:	1396876363
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHULI LEAH LOTAN MSW, PPSC

Provider Business Mailing Address
First Line	:	1717 4TH ST
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90401-3319
Country	:	US
Telephone Number	:	310-395-3204
Fax Number	:

Provider Business Practice Location Address
First Line	:	601 PICO BLVD
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90405-1224
Country	:	US
Telephone Number	:	310-395-3204
Fax Number	:

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

Provider Enumeration Date	:	03/08/2007
Last Update Date	:	12/12/2025

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