Healthcare Provider Details

I. General information

NPI: 1689949018
Provider Name (Legal Business Name): MICHAEL S. REDER, M.D., A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2012
Last Update Date: 03/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16500 VENTURA BLVD SUITE 320
ENCINO CA
91436-2011
US

IV. Provider business mailing address

16500 VENTURA BLVD SUITE 320
ENCINO CA
91436-2011
US

V. Phone/Fax

Practice location:
  • Phone: 818-986-1200
  • Fax: 818-986-3011
Mailing address:
  • Phone: 818-986-1200
  • Fax: 818-986-3011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number34552
License Number StateCA

VIII. Authorized Official

Name: MS. FRAN L FLEVOTOMOS
Title or Position: OFFICE MANAGER
Credential:
Phone: 818-986-1200