Healthcare Provider Details

I. General information

NPI: 1487911087
Provider Name (Legal Business Name): HEALTH SOLUTIONS PHYSICAL MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2012
Last Update Date: 04/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14622 VENTURA BLVD STE 205
SHERMAN OAKS CA
91403-3600
US

IV. Provider business mailing address

14622 VENTURA BLVD STE 205
SHERMAN OAKS CA
91403-3600
US

V. Phone/Fax

Practice location:
  • Phone: 818-985-5500
  • Fax:
Mailing address:
  • Phone: 818-985-5500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA72017
License Number StateCA

VIII. Authorized Official

Name: DR. JEFFREY DAVID KATLEIN
Title or Position: CEO
Credential: DC
Phone: 818-985-5500