Healthcare Provider Details

I. General information

NPI: 1609969997
Provider Name (Legal Business Name): MARIA LILIBETH T. SY, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8162 VAN NUYS BLVD
PANORAMA CITY CA
91402-4806
US

IV. Provider business mailing address

PO BOX 317
LA CANADA CA
91012-0317
US

V. Phone/Fax

Practice location:
  • Phone: 818-787-5800
  • Fax: 818-787-5810
Mailing address:
  • Phone: 818-787-5800
  • Fax: 818-787-5810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: MARIA LILIBETH TAN SY
Title or Position: PRESIDENT/OWNER
Credential: M.D.
Phone: 818-787-5800