Healthcare Provider Details

I. General information

NPI: 1962793695
Provider Name (Legal Business Name): RL DOYAN MD, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2011
Last Update Date: 11/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 S GLENDALE AVE SUITE 200
GLENDALE CA
91205-5612
US

IV. Provider business mailing address

1241 S GLENDALE AVE SUITE 201
GLENDALE CA
91205-3385
US

V. Phone/Fax

Practice location:
  • Phone: 818-244-5444
  • Fax: 818-243-0193
Mailing address:
  • Phone: 818-244-5444
  • Fax: 818-243-0193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberC50937
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: RICHARD L DOYAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 81824454444