1003102781 NPI number — CHILDREN'S HOSPITAL LOS ANGELES

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003102781 NPI number — CHILDREN'S HOSPITAL LOS ANGELES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHILDREN'S HOSPITAL LOS ANGELES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003102781
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/21/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7512 HAMPTON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST HOLLYWOOD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90046-5503
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
323-798-5487
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4650 W SUNSET BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90027-6062
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-361-3644
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/22/2011

Additional Information

Authorized Official

Authorized Official Last Name:
LIEBERENZ
Authorized Official First Name:
MAX
Authorized Official Middle Name:
SCOTT
Authorized Official Title or Position:
SR.VP/CFO
Authorized Official Telephone Number:
323-361-2235

Provider Taxonomy Codes

  • Taxonomy code: 282NC2000X , with the licence number:  A108600 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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