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Organization
POWERPLAY MD
Active
Organization
POWERPLAY MD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LYDIE HAZAN MD (CEO/PRESIDENT)
(310) 289-8242
Entity
Organization
Contact information
Practice address
5800 WILSHIRE BOULEVARD, LOS ANGELES, CA 90036
(310) 289-8242
(310) 289-8248
Mailing address
5800 WILSHIRE BOULEVARD, LOS ANGELES, CA 90036
(310) 289-8242
(310) 289-8248
Taxonomy
Speciality
Code
Description
License number
State
133VN1004X
Pediatric Nutrition Registered Dietitian
Primary
A53116
CA
Other
Enumeration date
10/29/2009
Last updated
10/29/2009
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