Provider Demographics
NPI:1306274113
Name:CHILDREN'S HOSPITAL LOS ANGELES
Entity type:Organization
Organization Name:CHILDREN'S HOSPITAL LOS ANGELES
Other - Org Name:<UNAVAIL>
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 RM 1503
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:323-361-8839
Mailing Address - Fax:323-361-7135
Practice Address - Street 1:4650 W SUNSET BLVD RM 1503
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:323-361-8839
Practice Address - Fax:323-361-7135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-15
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CA539223336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2158723OtherPK