Provider Demographics
NPI:1124073366
Name:CHILDRENS HOSPITAL OF LOS ANGELES
Entity type:Organization
Organization Name:CHILDRENS HOSPITAL OF LOS ANGELES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR.VP/CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:MAX
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:LIEBERENZ
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:323-361-2235
Mailing Address - Street 1:4650 W SUNSET BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-6062
Mailing Address - Country:US
Mailing Address - Phone:323-669-2202
Mailing Address - Fax:323-668-7951
Practice Address - Street 1:4650 W SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-6062
Practice Address - Country:US
Practice Address - Phone:323-669-2202
Practice Address - Fax:323-668-7951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QU0200X, 171M00000X, 261QA1903X, 261QC0050X
CA930000032282NC2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes282NC2000XHospitalsGeneral Acute Care HospitalChildren
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No261QC0050XAmbulatory Health Care FacilitiesClinic/CenterCritical Access Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1189050Medicaid
CA053302OtherBLUE CROSS
CAHSC30123FMedicaid
CA681051OtherCHAMPUS
CAZZZH19032OtherBLUE SHIELD
CAZZT40123FMedicaid
CAZZZH19032OtherBLUE SHIELD