Healthcare Provider Details

I. General information

NPI: 1912840273
Provider Name (Legal Business Name): MEDISERVE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2026
Last Update Date: 04/13/2026
Certification Date: 04/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7441 VANALDEN AVE
RESEDA CA
91335-2524
US

IV. Provider business mailing address

7945 YOLANDA AVE
RESEDA CA
91335-1857
US

V. Phone/Fax

Practice location:
  • Phone: 818-609-0777
  • Fax:
Mailing address:
  • Phone: 818-609-0777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name: ANDREW T COCHRAN
Title or Position: OWNER
Credential:
Phone: 818-609-0777