Healthcare Provider Details

I. General information

NPI: 1225180532
Provider Name (Legal Business Name): EDUARDO SOLOVERA URENDA PH D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10605 BALBOA BLVD SUITENUMBER100
GRANADA HILLS CA
91344-6342
US

IV. Provider business mailing address

19919 LASSEN ST
CHATSWORTH CA
91311-5539
US

V. Phone/Fax

Practice location:
  • Phone: 818-832-2400
  • Fax:
Mailing address:
  • Phone: 818-886-4685
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: