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Provider Information for 1740441542

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know


Gender: FEMALE

Individual NPI: 1740441542

Calendar   Last Updated:  2011-11-28
  Certification Date: 


Name Value
NPI 1740441542
Enumeration Date 2008-06-24
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 5767 W CENTURY BLVD
LOS ANGELES, CA 90045-5631
United States

Phone: 310-392-8636 | Fax: 310-829-4632
View Map External Link
Primary Practice Address 1920 COLORADO AVE
SANTA MONICA, CA 90404-3414
United States

Phone: 310-319-4700 | Fax: 310-453-5106
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
MEDICAID CA 1740441542
Primary Taxonomy Selected Taxonomy State License Number
Yes 207Q00000X - Family Medicine CA A107530