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MR. CHARLES WALLACE WICKLIFFE
NPI 1871663054
Recreation Therapist in Los Angeles, CA

Active since November 08, 2006
11301 WILSHIRE BLVD, 117R, LOS ANGELES, CA 90073(310) 478-3711 Get Directions Write a Review

NPPES record last updated: July 8, 2007. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Mr. Charles Wallace Wickliffe NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MR. CHARLES WALLACE WICKLIFFE (NPI 1871663054) is an individual recreation therapist in Los Angeles, California and active in the NPI registry since November 2006.

NPPES Registry Identity

NPI1871663054
Entity TypeIndividualMale
Primary Taxonomy225800000X
Provider Legal NameMR. CHARLES WALLACE WICKLIFFE
Location Address11301 WILSHIRE BLVD, 117RLos Angeles, CA 90073-1003
Mailing Address5274 Parkglen AveLos Angeles, CA 90043-1030 · (323) 299-9755
Phone(310) 478-3711
Sole ProprietorYes
Enumeration DateNovember 8, 2006
Last NPPES UpdateJuly 8, 2007
✔ NPI 1871663054 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyRecreation TherapistRespiratory, Developmental, Rehabilitative and Restorative Service Providers
Taxonomy Code225800000X
Definition
A recreation therapist uses recreational activities for intervention in some physical, social or emotional behavior to bring about a desired change in that behavior and promote the growth and development of the patient.
11301 WILSHIRE BLVD, Los Angeles, CA 90073
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Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

JOANNA ZUHAIL CENTENO I
Licensed Vocational Nurse
11301 WILSHIRE BLVD
LOS ANGELES, CA 90073
Los Angeles County (310) 478-3711
MS. APRIL S. BULLOCK MSW,ACSW
Social Worker
11301 WILSHIRE BLVD
LOS ANGELES, CA 90073
Los Angeles County (310) 268-3000
NICOLE CHAN LISW
Social Worker
11301 WILSHIRE BLVD
LOS ANGELES, CA 90073
Los Angeles County (310) 487-6026
DANIEL SMEE SOCIAL WORK
Social Worker (Clinical)
11301 WILSHIRE BLVD
LOS ANGELES, CA 90073
Los Angeles County (310) 478-3711
AMANDA SALVESTRINI MS, RD
Dietitian, Registered
11301 WILSHIRE BLVD, BUILDING 213. 3RD FLOOR. ROOM 317.
LOS ANGELES, CA 90073
Los Angeles County (310) 478-3711
RACHEL DAJANI MD
Internal Medicine
11301 WILSHIRE BLVD
LOS ANGELES, CA 90073
Los Angeles County (310) 478-3711
HARRISON BODRIE LCSW
Social Worker (Clinical)
11301 WILSHIRE BLVD
LOS ANGELES, CA 90073
Los Angeles County (310) 987-8310
MR. ROBERTO CARMONA-VERGARA ASW
Social Worker
11301 WILSHIRE BLVD
LOS ANGELES, CA 90073
Los Angeles County (310) 478-3711

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Charles Wickliffe's NPI number?

The NPI number for Charles Wickliffe is 1871663054. It was assigned to this individual provider in the NPPES registry on November 8, 2006.

Where is Charles Wickliffe located?

Charles Wickliffe practices at 11301 Wilshire Blvd 117R, Los Angeles, CA 90073. The listed phone number is (310) 478-3711.

What is Charles Wickliffe's specialty?

The primary specialty registered for this NPI is Recreation Therapist with taxonomy code 225800000X.

When was this NPI record last updated?

The NPPES record for Charles Wickliffe was last updated on July 8, 2007. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 19 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.