MEDICARE: EYAL SHTORCH MD

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	A64854	CA
2	207RN0300X	Nephrology Physician	A64854	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942395603
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EYAL SHTORCH MD

Provider Business Mailing Address
First Line	:	18040 SHERMAN WAY STE 210
Second Line	:
City	:	RESEDA
State	:	CA
Zip	:	91335-4656
Country	:	US
Telephone Number	:	424-421-6001
Fax Number	:	818-239-4239

Provider Business Practice Location Address
First Line	:	18040 SHERMAN WAY STE 210
Second Line	:
City	:	RESEDA
State	:	CA
Zip	:	91335-4656
Country	:	US
Telephone Number	:	424-421-6001
Fax Number	:	818-239-4239

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	05/31/2023

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