Healthcare Provider Details

I. General information

NPI: 1104079110
Provider Name (Legal Business Name): ERIN WYNER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2008
Last Update Date: 08/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7223 FAIR AVE
SUN VALLEY CA
91352-4964
US

IV. Provider business mailing address

7223 FAIR AVE
SUN VALLEY CA
91352-4964
US

V. Phone/Fax

Practice location:
  • Phone: 818-432-4400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA103089
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: