Provider Demographics
NPI:1861643900
Name:LAUREN SWERDLOFF, MD A MEDICAL PROFESSIONAL CORP
Entity Type:Organization
Organization Name:LAUREN SWERDLOFF, MD A MEDICAL PROFESSIONAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:CIEL
Authorized Official - Last Name:SWERDLOFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-829-5189
Mailing Address - Street 1:1821 WILSHIRE BLVD STE 220
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-5627
Mailing Address - Country:US
Mailing Address - Phone:310-829-5189
Mailing Address - Fax:310-829-5942
Practice Address - Street 1:1821 WILSHIRE BLVD STE 220
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-5627
Practice Address - Country:US
Practice Address - Phone:310-829-5189
Practice Address - Fax:310-829-5942
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-07
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG67752261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G677520Medicaid
CAE93095Medicare UPIN
CA00G677520Medicaid