Provider Demographics
NPI:1134963309
Name:LIFELINE WALK IN MEDICAL & MENTAL HEALTH NURSING CLINIC, INC
Entity type:Organization
Organization Name:LIFELINE WALK IN MEDICAL & MENTAL HEALTH NURSING CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:ANULIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHILAKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-736-2517
Mailing Address - Street 1:3535 TORRANCE BLVD STE 13
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-4815
Mailing Address - Country:US
Mailing Address - Phone:310-736-2517
Mailing Address - Fax:
Practice Address - Street 1:3535 TORRANCE BLVD STE 13
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-4815
Practice Address - Country:US
Practice Address - Phone:310-736-2517
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-22
Last Update Date:2024-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1679140644OtherPSYCHIATRIC MENTAL HEALTH NURSE PRACTITIONER