MEDICARE: FEISTY GAL INC.

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	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1841936648
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FEISTY GAL INC.

Provider Business Mailing Address
First Line	:	14320 VENTURA BLVD STE 418
Second Line	:
City	:	SHERMAN OAKS
State	:	CA
Zip	:	91423-2717
Country	:	US
Telephone Number	:	323-309-7567
Fax Number	:

Provider Business Practice Location Address
First Line	:	6957 COLUMBUS AVE
Second Line	:
City	:	VAN NUYS
State	:	CA
Zip	:	91405-3559
Country	:	US
Telephone Number	:	323-309-7567
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MICHELLE LANDER
Credential	:
Telephone Number	:	323-309-7567

Provider Enumeration Date	:	05/05/2022
Last Update Date	:	05/05/2022

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Directions to “FEISTY GAL INC. ” Practice Location

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