Healthcare Provider Details

I. General information

NPI: 1982917654
Provider Name (Legal Business Name): SM MED CORP, APC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2010
Last Update Date: 07/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 VAN NUYS BLVD SUITE 210
SHERMAN OAKS CA
91403-1793
US

IV. Provider business mailing address

PO BOX 260920
ENCINO CA
91426-0920
US

V. Phone/Fax

Practice location:
  • Phone: 818-465-6614
  • Fax:
Mailing address:
  • Phone: 818-465-6614
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberA75531
License Number StateCA

VIII. Authorized Official

Name: ROCHELLE GREEB
Title or Position: BILLING MANAGER
Credential:
Phone: 818-465-6614