Healthcare Provider Details

I. General information

NPI: 1558920843
Provider Name (Legal Business Name): LIBERTYMED HEALTH GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2019
Last Update Date: 02/12/2024
Certification Date: 02/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 W GLENOAKS BLVD STE D
GLENDALE CA
91202-2664
US

IV. Provider business mailing address

900 W GLENOAKS BLVD STE D
GLENDALE CA
91202-2664
US

V. Phone/Fax

Practice location:
  • Phone: 818-241-4129
  • Fax: 818-241-0472
Mailing address:
  • Phone: 818-241-4129
  • Fax: 818-241-0472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: RIMA VOSKANI
Title or Position: MANAGER
Credential:
Phone: 818-248-2000