Provider Demographics
NPI:1154577948
Name:CARLA E. HERRIFORD, M.D., APC
Entity type:Organization
Organization Name:CARLA E. HERRIFORD, M.D., APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:HERRIFORD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-339-2979
Mailing Address - Street 1:12021 WILMINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90059-3019
Mailing Address - Country:US
Mailing Address - Phone:310-668-5172
Mailing Address - Fax:
Practice Address - Street 1:4071 PUNTA ALTA DR
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90008-1130
Practice Address - Country:US
Practice Address - Phone:310-339-2979
Practice Address - Fax:310-339-2979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-12
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC40031174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC40031BMedicare PIN
CAA88159Medicare UPIN