Healthcare Provider Details

I. General information

NPI: 1366408577
Provider Name (Legal Business Name): TERRY E PODELL MD A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 02/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16133 VENTURA BLVD SUITE 400
ENCINO CA
91436-2429
US

IV. Provider business mailing address

16133 VENTURA BLVD SUITE 400
ENCINO CA
91436-2429
US

V. Phone/Fax

Practice location:
  • Phone: 818-528-1020
  • Fax: 818-528-1021
Mailing address:
  • Phone: 818-528-1020
  • Fax: 818-528-1021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: TERRY E PODELL
Title or Position: PRESIDENT
Credential: MD
Phone: 818-528-1020