Healthcare Provider Details

I. General information

NPI: 1073866877
Provider Name (Legal Business Name): MR. DAVID MORGAN SKINNER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2012
Last Update Date: 03/25/2020
Certification Date: 03/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20151 NORDHOFF ST
CHATSWORTH CA
91311-6215
US

IV. Provider business mailing address

20151 NORDHOFF ST
CHATSWORTH CA
91311-6215
US

V. Phone/Fax

Practice location:
  • Phone: 818-407-3200
  • Fax: 818-775-4552
Mailing address:
  • Phone: 818-407-3200
  • Fax: 818-775-4552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: