Healthcare Provider Details

I. General information

NPI: 1356963417
Provider Name (Legal Business Name): ATALLA MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2020
Last Update Date: 02/03/2026
Certification Date: 02/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

557 N MACLAY AVE
SAN FERNANDO CA
91340-2424
US

IV. Provider business mailing address

9839 BELMAR AVE
NORTHRIDGE CA
91324-1655
US

V. Phone/Fax

Practice location:
  • Phone: 818-639-0210
  • Fax:
Mailing address:
  • Phone: 559-804-3130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: MARTHA I ATALLA
Title or Position: MD
Credential: MD
Phone: 630-935-7306