Healthcare Provider Details

I. General information

NPI: 1508016874
Provider Name (Legal Business Name): LONGVIEW MEDICAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2008
Last Update Date: 09/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12400 VENTURA BLVD SUITE 526
STUDIO CITY CA
91604-2406
US

IV. Provider business mailing address

12400 VENTURA BLVD SUITE 526
STUDIO CITY CA
91604-2406
US

V. Phone/Fax

Practice location:
  • Phone: 818-915-3820
  • Fax:
Mailing address:
  • Phone: 818-915-3820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberG33624
License Number StateCA

VIII. Authorized Official

Name: STEVEN GRANT JOHNSON
Title or Position: CEO
Credential: MD
Phone: 818-915-3820