Healthcare Provider Details

I. General information

NPI: 1225208606
Provider Name (Legal Business Name): RHEUMATOLOGY ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2008
Last Update Date: 06/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12660 RIVERSIDE DR SUITE 200
NORTH HOLLYWOOD CA
91607-3430
US

IV. Provider business mailing address

12660 RIVERSIDE DR SUITE 200
NORTH HOLLYWOOD CA
91607-3429
US

V. Phone/Fax

Practice location:
  • Phone: 818-980-7010
  • Fax: 818-980-7330
Mailing address:
  • Phone: 818-980-7010
  • Fax: 818-980-7330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SEAN JOSEPH WOLLASTON
Title or Position: CO PARTNER
Credential: M.D.
Phone: 818-980-7010