Individual
DR. COLLEEN LUCY CHANNICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1223 16TH ST STE 3400, SANTA MONICA, CA 90404-1279
(310) 449-0939
Mailing address
5767 W CENTURY BLVD STE 400, LOS ANGELES, CA 90045-5631
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
A64140
CA
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
A64140
CA
207RP1001X
Pulmonary Disease Physician
Primary
A64140
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A641400
—
CA
Enumeration date
07/11/2006
Last updated
07/05/2019
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