Provider Demographics
NPI:1790929511
Name:CHILDREN'S HOSPITAL LOS ANGELES
Entity Type:Organization
Organization Name:CHILDREN'S HOSPITAL LOS ANGELES
Other - Org Name:
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
Mailing Address - Street 2:MAILBOX # 44
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-6062
Mailing Address - Country:US
Mailing Address - Phone:323-361-2406
Mailing Address - Fax:323-664-0326
Practice Address - Street 1:4650 W SUNSET BLVD
Practice Address - Street 2:MAILBOX # 44
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-6062
Practice Address - Country:US
Practice Address - Phone:323-361-2406
Practice Address - Fax:323-664-0326
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHILDRENS HOSPITAL LOS ANGELES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-04-23
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHSP13726333600000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy