Healthcare Provider Details

I. General information

NPI: 1083616031
Provider Name (Legal Business Name): KAREN I VIRLEY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2005
Last Update Date: 07/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12660 RIVERSIDE DR STE 310
N HOLLYWOOD CA
91607-3431
US

IV. Provider business mailing address

8510 BALBOA BLVD 150
NORTHRIDGE CA
91325-5810
US

V. Phone/Fax

Practice location:
  • Phone: 818-755-0391
  • Fax: 818-753-8165
Mailing address:
  • Phone: 818-637-2000
  • Fax: 818-654-3417

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberG83474
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: