Healthcare Provider Details

I. General information

NPI: 1033421805
Provider Name (Legal Business Name): KAREN TENENBLATT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2010
Last Update Date: 02/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

358 KANAN RD
OAK PARK CA
91377
US

IV. Provider business mailing address

358 KANAN RD
OAK PARK CA
91377-1111
US

V. Phone/Fax

Practice location:
  • Phone: 818-707-0046
  • Fax:
Mailing address:
  • Phone: 818-707-0046
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA140300
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: