NPIMap

Organization Active NPI

Craniofacial/Cleft Palate Program

  • Specialist
  • Los Angeles, CA
National Provider Identifier
1093959900
Registry record updated Aug 18, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
CRANIOFACIAL/CLEFT PALATE PROGRAM
Practice address
403 W Adams Blvd
4TH Floor
Los Angeles, CA 90007-2664
Phone
(213) 742-1433
Fax
(213) 742-1496
NPI assigned
Apr 22, 2009
Last updated
Aug 18, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 18, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Libby F Wilson, M.D.,NPI 1568405546
Title
Plastic Surgeon
Phone
(213) 742-1433

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X NU Primary

Addresses

Primary practice location

403 W Adams Blvd
4TH Floor
Los Angeles, CA 90007-2664

Mailing address

403 W Adams Blvd
4TH Floor
Los Angeles, CA 90007-2664
Phone (213) 742-1433

Other names 1

  • Cleft palate program medical practice group Former legal business name

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1240358400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1439856000000",
    "number": "1093959900",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "403 W ADAMS BLVD",
            "address_2": "4TH FLOOR",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900072664",
            "telephone_number": "213-742-1433",
            "fax_number": "213-742-1496"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "403 W ADAMS BLVD",
            "address_2": "4TH FLOOR",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900072664",
            "telephone_number": "213-742-1433",
            "fax_number": "213-742-1496"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRANIOFACIAL/CLEFT PALATE PROGRAM",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-04-22",
        "last_updated": "2015-08-18",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "LIBBY",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "PLASTIC SURGEON",
        "authorized_official_telephone_number": "213-742-1433",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D.,"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cleft palate program medical practice group",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Los Angeles, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.