Healthcare Provider Details

I. General information

NPI: 1982741914
Provider Name (Legal Business Name): GARY L. ARENDS JR., D.O. APC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 01/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 S. BUENA VISTA ST. SUITE #410
BURBANK CA
91505-4554
US

IV. Provider business mailing address

201 S. BUENA VISTA ST. SUITE #410
BURBANK CA
91505-4554
US

V. Phone/Fax

Practice location:
  • Phone: 818-845-5332
  • Fax: 818-557-7781
Mailing address:
  • Phone: 818-845-5332
  • Fax: 818-557-7781

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number20A8430
License Number StateCA

VIII. Authorized Official

Name: GARY L. ARENDS JR.
Title or Position: PRESIDENT / CEO
Credential: D.O.
Phone: 818-845-5332