Provider Demographics
NPI:1407108061
Name:WACHEL, LIDA (NP)
Entity Type:Individual
Prefix:
First Name:LIDA
Middle Name:
Last Name:WACHEL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:LIDA
Other - Middle Name:
Other - Last Name:WESTBROOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, NP
Mailing Address - Street 1:5120 W GOLDLEAF CIR
Mailing Address - Street 2:250
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90056-1278
Mailing Address - Country:US
Mailing Address - Phone:323-446-4493
Mailing Address - Fax:323-544-4987
Practice Address - Street 1:5120 W GOLDLEAF CIRCLE
Practice Address - Street 2:SUITE 250
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90056-1278
Practice Address - Country:US
Practice Address - Phone:323-446-4493
Practice Address - Fax:323-544-4987
Is Sole Proprietor?:No
Enumeration Date:2012-10-08
Last Update Date:2016-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA319612, NP 19398363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology