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Specialty details in registry · Los Angeles, CA

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At a glance

6078 Selma Ave, Los Angeles, CA 90028-6415

NPPES record updated Aug 5, 2018. Public records can lag behind changes at a practice.

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Insurance participation and appointment availability are not established by these public records.

Practice location

6078 Selma Ave
Los Angeles, CA 90028-6415

Additional reported practice locations

6081 Harold Way
Los Angeles, CA 900286403
Phone: 3104993112
6082 Selma Ave
Los Angeles, CA 900286415
Phone: 3104993122
6083 Harold Way
Los Angeles, CA 900286403
Phone: 3104993112
Professional details: NPI, taxonomy & registry record
NPI1437637014
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Registry details

Primary taxonomy
Specialty details in registry
Taxonomy code
324500000X
Enumeration date
Aug 5, 2018
Record updated
Aug 5, 2018
More registry details
Provider type
Organization · Type 2
Other reported name
<UNAVAIL>

Reported taxonomies and licenses

Specialty details in registry

324500000X · Primary

License numbers and credentials are reported to NPPES; HCPList does not independently verify them.

Practice location

6078 Selma Ave
Los Angeles, CA 90028-6415
Phone
(310) 499-3112
Mailing address
12801 MILBANK ST

STUDIO CITY, CA 916041354
Source: NPPES Source through Oct 18, 2026An NPI does not verify licensure or credentials.

Information may be outdated or incomplete. Confirm details directly with the practice. HCPList is an independent directory and is not affiliated with CMS.

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