Healthcare Provider Details

I. General information

NPI: 1609074806
Provider Name (Legal Business Name): PACIFIC GYNECOLOGIC SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2007
Last Update Date: 08/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

181 SOUTH BUENA VISTA STREET 3RD FLOOR
BURBANK CA
91505-1204
US

IV. Provider business mailing address

P.O, BOX 8410
PASADENA CA
91109-8410
US

V. Phone/Fax

Practice location:
  • Phone: 818-847-4436
  • Fax: 818-847-4432
Mailing address:
  • Phone: 818-847-4436
  • Fax: 818-847-4432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License NumberGR0103810
License Number StateCA

VIII. Authorized Official

Name: RICHARD LEE FRIEDMAN
Title or Position: MANAGING PARTNER
Credential: M.D.
Phone: 818-847-4436