Healthcare Provider Details

I. General information

NPI: 1285642033
Provider Name (Legal Business Name): NORTHRIDGE FAMILY PRACTICE MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 11/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18406 ROSCOE BLVD
NORTHRIDGE CA
91325
US

IV. Provider business mailing address

18406 ROSCOE BLVD
NORTHRIDGE CA
91325
US

V. Phone/Fax

Practice location:
  • Phone: 818-885-5480
  • Fax: 818-885-5430
Mailing address:
  • Phone: 818-885-5480
  • Fax: 818-885-5430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. PAMELA M DAVIS
Title or Position: DIRECTOR
Credential: MD
Phone: 818-885-5480