Healthcare Provider Details

I. General information

NPI: 1346261617
Provider Name (Legal Business Name): NORTHRIDGE DERMATOLOGY ASSOCIATES MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 03/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9535 RESEDA BOULEVARD SUITE 304
NORTHRIDGE CA
91324-6029
US

IV. Provider business mailing address

9535 RESEDA BOULEVARD SUITE 304
NORTHRIDGE CA
91324-6029
US

V. Phone/Fax

Practice location:
  • Phone: 818-886-3884
  • Fax: 818-886-5418
Mailing address:
  • Phone: 818-886-3884
  • Fax: 818-886-5418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: DAVID H FRIEDMAN
Title or Position: PRESIDENT
Credential: MD
Phone: 818-886-3884