Provider Demographics
NPI:1790071587
Name:BABCOCK, TRACI VICTORIA (NP)
Entity Type:Individual
Prefix:
First Name:TRACI
Middle Name:VICTORIA
Last Name:BABCOCK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8700 BEVERLY BLVD
Mailing Address - Street 2:THALIANS BLDG, SUITE E240
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90048-1804
Mailing Address - Country:US
Mailing Address - Phone:310-423-5094
Mailing Address - Fax:310-967-0601
Practice Address - Street 1:8700 BEVERLY BLVD
Practice Address - Street 2:THALIANS BLDG, SUITE E240
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90048-1804
Practice Address - Country:US
Practice Address - Phone:310-423-5094
Practice Address - Fax:310-967-0601
Is Sole Proprietor?:No
Enumeration Date:2011-06-21
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA8111363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health