Healthcare Provider Details

I. General information

NPI: 1407164221
Provider Name (Legal Business Name): LAUREL CANYON MEDICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2010
Last Update Date: 09/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8002 LAUREL CANYON BLVD
NORTH HOLLYWOOD CA
91605-1427
US

IV. Provider business mailing address

8002 LAUREL CANYON BLVD
NORTH HOLLYWOOD CA
91605-1427
US

V. Phone/Fax

Practice location:
  • Phone: 818-768-5700
  • Fax: 818-768-5710
Mailing address:
  • Phone: 818-768-5700
  • Fax: 818-768-5710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberG47581
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: STANTON S KREMSKY
Title or Position: PRESIDENT
Credential: MD
Phone: 818-768-5700