Healthcare Provider Details

I. General information

NPI: 1356889836
Provider Name (Legal Business Name): MEN'S HEALTH FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2017
Last Update Date: 10/28/2021
Certification Date: 08/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9201 W SUNSET BLVD STE 812
LOS ANGELES CA
90069-3709
US

IV. Provider business mailing address

9201 W SUNSET BLVD STE 812
LOS ANGELES CA
90069-3709
US

V. Phone/Fax

Practice location:
  • Phone: 310-550-1010
  • Fax: 310-550-0650
Mailing address:
  • Phone: 310-550-1010
  • Fax: 310-550-0650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA44497
License Number StateCA

VIII. Authorized Official

Name: ANTHONY MILLS
Title or Position: EXECUTIVE DIRECTOR
Credential: MD
Phone: 310-550-1010