Provider Demographics
NPI:1821344227
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:SVP AND CHIEF CLINICAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, RN, NEA-BC
Authorized Official - Phone:323-361-2476
Mailing Address - Street 1:4650 W SUNSET BLVD
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:323-361-4624
Mailing Address - Fax:
Practice Address - Street 1:4650 W SUNSET BLVD
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:323-361-4141
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHILDREN'S HOSPITAL LOS ANGELES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-08-03
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No332900000XSuppliersNon-Pharmacy Dispensing Site