MEDICARE: GARY H NUDELL M D A PROFESSIONAL CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	A64512	CA

General Provider Information

NPI Number	:	1043567662
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GARY H NUDELL M D A PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	7345 MEDICAL CENTER DR STE 160
Second Line	:
City	:	WEST HILLS
State	:	CA
Zip	:	91307-1952
Country	:	US
Telephone Number	:	818-676-4806
Fax Number	:	818-678-4820

Provider Business Practice Location Address
First Line	:	7345 MEDICAL CENTER DR STE 160
Second Line	:
City	:	WEST HILLS
State	:	CA
Zip	:	91307-1952
Country	:	US
Telephone Number	:	818-676-4806
Fax Number	:	818-676-4820

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	DR. GARY HOWARD NUDELL
Credential	:	M.D.
Telephone Number	:	818-676-4806

Provider Enumeration Date	:	08/14/2012
Last Update Date	:	11/08/2023

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