Healthcare Provider Details

I. General information

NPI: 1003501974
Provider Name (Legal Business Name): ERIC TYLER AMPARAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2023
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5400 BALBOA BLVD STE 326
ENCINO CA
91316-5214
US

IV. Provider business mailing address

5400 BALBOA BLVD STE 326
ENCINO CA
91316-5214
US

V. Phone/Fax

Practice location:
  • Phone: 818-789-0941
  • Fax: 818-789-6726
Mailing address:
  • Phone: 818-789-0941
  • Fax: 818-789-6726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA208135
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: