Individual
TRACEY R CHILDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2001 SANTA MONICA BLVD STE 680W, SANTA MONICA, CA 90404-2111
(310) 829-8928
(310) 315-6157
Mailing address
2021 SANTA MONICA BLVD, STE 625E, SANTA MONICA, CA 90404-2208
(310) 453-8838
(310) 453-8355
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
G73993
CA
208C00000X
Colon & Rectal Surgery Physician
G73993
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00G739930
MEDI-CAL PPIN #
CA
05
—
1114999489
—
CA
Enumeration date
02/02/2006
Last updated
04/21/2023
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