MEDICARE: WOMENS AND CHILDRENS HOSPITAL

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	282NW0100X	Women's Hospital	A97330	CA

General Provider Information

NPI Number	:	1639362981
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WOMENS AND CHILDRENS HOSPITAL

Provider Business Mailing Address
First Line	:	1240 NORTH MISISON ROAD
Second Line	:	ROOM 5K-13
City	:	LOS ANGELES
State	:	CA
Zip	:	90033
Country	:	US
Telephone Number	:	909-240-6671
Fax Number	:

Provider Business Practice Location Address
First Line	:	1240 NORTH MISISON RD
Second Line	:	ROOM 5K-13
City	:	LOS ANGELES
State	:	CA
Zip	:	90033
Country	:	US
Telephone Number	:	909-240-6671
Fax Number	:

Authorized Official
Title or Position	:	PGY-3 OB/GYN
Name	:	DR. ELIZABETH FELIX-TRUNNELLE
Credential	:	M.D.
Telephone Number	:	909-240-6671

Provider Enumeration Date	:	08/21/2007
Last Update Date	:	08/21/2007

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