MEDICARE: SOUSANNA LACHTCHOUK NP

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	363L00000X	Nurse Practitioner	NP11055	CA
2	363LF0000X	Family Nurse Practitioner	NP11055	CA
3	363LP2300X	Primary Care Nurse Practitioner	NP11055	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1982654844
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SOUSANNA LACHTCHOUK NP

Provider Business Mailing Address
First Line	:	6200 WILSHIRE BLVD
Second Line	:	SUITE 1212
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-5813
Country	:	US
Telephone Number	:	323-933-7200
Fax Number	:	323-933-7250

Provider Business Practice Location Address
First Line	:	6200 WILSHIRE BLVD
Second Line	:	SUITE 1212
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-5813
Country	:	US
Telephone Number	:	323-933-7200
Fax Number	:	323-933-7250

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

Provider Enumeration Date	:	05/11/2006
Last Update Date	:	09/11/2025

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