Healthcare Provider Details

I. General information

NPI: 1578517033
Provider Name (Legal Business Name): ENCINO FAMILY HEALTH ASSOCIATES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 03/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16661 VENTURA BLVD SUITE #820
ENCINO CA
91436-1914
US

IV. Provider business mailing address

16661 VENTURA BLVD SUITE #820
ENCINO CA
91436-1914
US

V. Phone/Fax

Practice location:
  • Phone: 818-808-0037
  • Fax: 818-808-0039
Mailing address:
  • Phone: 818-808-0037
  • Fax: 818-808-0039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. KAMI ADIBI
Title or Position: SOLE OWNER
Credential: M.D.
Phone: 818-808-0037