Healthcare Provider Details

I. General information

NPI: 1114643087
Provider Name (Legal Business Name): GISELLE NAMAZIE MD A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2022
Last Update Date: 10/12/2022
Certification Date: 10/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16661 VENTURA BLVD STE 226
ENCINO CA
91436-1947
US

IV. Provider business mailing address

16661 VENTURA BLVD STE 226
ENCINO CA
91436-1947
US

V. Phone/Fax

Practice location:
  • Phone: 818-796-2070
  • Fax: 818-986-5503
Mailing address:
  • Phone: 818-796-2070
  • Fax: 818-986-5503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. GISELLE CABELLO NAMAZIE
Title or Position: CEO
Credential: MD
Phone: 818-343-0559