Healthcare Provider Details

I. General information

NPI: 1982684031
Provider Name (Legal Business Name): GISELLE CABELLO NAMAZIE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2006
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: 818-986-5500
  • Fax:
Mailing address:
  • Phone: 818-986-5500
  • Fax: 818-986-5503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA55710
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: