CRANIOFACIAL/CLEFT PALATE PROGRAM (NPI# 1093959900) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1093959900 |
| Entity Type | Organization |
| Organization Name | CRANIOFACIAL/CLEFT PALATE PROGRAM |
| Other Organization Name | CLEFT PALATE PROGRAM MEDICAL PRACTICE GROUP |
| Practice Address |
403 W Adams Blvd 4th Floor Los Angeles CA 90007-2664 |
| Practice Telephone | 2137421433 |
| Practice Fax Number | 2137421496 |
| Mailing Telephone | 2137421433 |
| Mailing Fax Number | 2137421496 |
| Enumeration Date | 2009-04-22 |
| Last Update Date | 2015-08-18 |
| Authorized Official Name | DR. LIBBY F WILSON (PLASTIC SURGEON) |
| Authorized Official Telephone | 2137421433 |
| Authorized Official Credential | M.D., |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 174400000X | Specialist | Other Service Providers |
| Other Name | Type Code |
|---|---|
| Cleft palate program medical practice group | Former Legal Business Name - Organization |
| Street Address |
403 W ADAMS BLVD 4TH FLOOR |
| City | LOS ANGELES |
| State | CA |
| Zip Code | 90007-2664 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831171602 | Orthopaedic Rehabilitation Specialists Inc | Occupational Therapist | 403 W Adams Blvd, Los Angeles, CA 90007-2664 | 2005-11-17 |
| 1851900856 | Enda Kelly | Student in an Organized Health Care Education/Training Program | 403 W Adams Blvd, Los Angeles, CA 90007-2664 | 2020-07-26 |
| 1902454051 | Alexandra Nicole Santellano-bartsch | Orthopaedic Surgery | 403 W Adams Blvd, Los Angeles, CA 90007-2664 | 2019-09-02 |
| 1063069730 | Mirna Aracely Guzman | Physical Therapy Assistant | 403 W Adams Blvd, Los Angeles, CA 90007-2664 | 2019-08-19 |
| 1578125035 | Help Them Smile | Voluntary or Charitable | 403 W Adams Blvd, Los Angeles, CA 90007-2664 | 2019-07-05 |
| 1376019919 | Summer Bloom Runestad | Specialist/Technologist | 403 W Adams Blvd, Los Angeles, CA 90007-2664 | 2018-10-22 |
| 1770090227 | Kathryn Williams | Nurse Practitioner | 403 W Adams Blvd, Los Angeles, CA 90007-2664 | 2018-01-05 |
| 1326581208 | Jessica Mofidi | Pediatrics | 403 W Adams Blvd, Los Angeles, CA 90007-2664 | 2016-11-28 |
| 1326402884 | Orthopaedic Institute for Children Ambulatory Surgery Center, LLC | Clinic/Center | 403 W Adams Blvd, Los Angeles, CA 90007-2664 | 2016-04-11 |
| 1396110425 | Christine Caron | Physical Therapist | 403 W Adams Blvd, Los Angeles, CA 90007-2664 | 2015-12-01 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093278632 | St. John's Well Child and Family Center, Inc. | Clinic/Center | 1060 West Exposition Blvd., Los Angeles, CA 90007 | 2019-04-10 |
| 1639690803 | Michelle Pittman | Registered Nurse | 2829 South Grand Ave., H. Claude Hudson Chc, Los Angeles, CA 90007 | 2017-06-28 |
| 1568983773 | Debbie Sharon Gillett | Registered Nurse | 2829 South Grand Avenue, H. Claude Hudson Health Center, Los Angeles, CA 90007 | 2017-06-28 |
| 1043749435 | Tamika Brown | Driver | 2947 Van Buren Place, Los Angeles, CA 90007 | 2017-06-08 |
| 1356891857 | Eli Gendler | General Practice | 2501 South Hill St., Los Angeles, CA 90007 | 2016-10-07 |
| 1770037715 | Jennifer R Knutson | Nurse Practitioner | 2409 S. Vermont Ave., Los Angeles, CA 90007 | 2016-08-08 |
| 1386006088 | Matthew Welzenbach | Internal Medicine | St. John's Well Child, 1910 Magnolia Ave #101, Los Angeles, CA 90007 | 2016-03-22 |
| 1316315765 | Gary L Nollins | Counselor | 145 W 22ns Street, Los Angeles, CA 90007 | 2015-09-02 |
| 1861882698 | Tarlan, P. Akhavan Dds A Prof Corp | Dentist | 2407 South Vermont Ave, Los Angeles, CA 90007 | 2015-02-02 |
| 1316341258 | Jessica Huang | Student in an Organized Health Care Education/Training Program | 854 West Adams Blvd, Los Angeles, CA 90007 | 2014-10-21 |
| Find all providers in zip 90007 | ||||
| Taxonomy Code | 174400000X |
| Grouping | Other Service Providers |
| Classification | Specialist |
| An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |
| Notes: Source: Expanded from Webster’s II New Riverside University Dictionary, Boston: Riverside Publishing Company, 1974. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255801098 | Maria Elizabeth Botham | Specialist | 8250 W 3rd St Ste 203, Los Angeles, CA 90048-4327 | 2018-12-04 |
| 1154899821 | Adam Garcia-morales | Specialist | 216 S Townsend Ave, Los Angeles, CA 90063-2439 | 2018-11-11 |
| 1174028930 | Sabrena Anne Smith | Specialist | 1680 Vine St Ste 908, Los Angeles, CA 90028-8838 | 2018-03-26 |
| 1538663513 | John Horton | Specialist | 760 Westwood Plaza, Resident Office, Los Angeles, CA 90024 | 2018-03-22 |
| 1598272262 | Ronna Lynne Pearl | Specialist | 3371 Glendale Blvd Ste 215, Los Angeles, CA 90039-1857 | 2018-01-04 |
| 1245754431 | Marla Ellen Mintz | Specialist | 11844 W Pico Blvd Ste 200, Los Angeles, CA 90064-1353 | 2017-07-28 |
| 1730619818 | Emily Ng | Specialist | 8590 W Pico Blvd, Los Angeles, CA 90035-2691 | 2017-06-12 |
| 1871044297 | Katherinne Aucaruri | Specialist | 4225 Blanchard St, Los Angeles, CA 90063-1317 | 2016-10-20 |
| 1720536923 | Jkc Neurology Medical Group Inc | Specialist | 3550 Wilshire Blvd Ste 650, Los Angeles, CA 90010-2440 | 2016-09-15 |
| 1932552916 | Anthony Jose Salvatierra | Specialist | 421 S Manhattan Pl Apt 9, Los Angeles, CA 90020-4175 | 2016-07-14 |
| Find all providers in LOS ANGELES | ||||
| City | LOS ANGELES |
| Zip Code | 90007 |
Please comment or provide details below to improve the information on CRANIOFACIAL/CLEFT PALATE PROGRAM.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.