Healthcare Provider Details

I. General information

NPI: 1407010374
Provider Name (Legal Business Name): DANA CHIDEKEL PH.DL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2008
Last Update Date: 07/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18321 VENTURA BLVD STE 510
TARZANA CA
91356-4248
US

IV. Provider business mailing address

18321 VENTURA BLVD STE 510
TARZANA CA
91356-4248
US

V. Phone/Fax

Practice location:
  • Phone: 818-705-4305
  • Fax: 818-705-4307
Mailing address:
  • Phone: 818-705-4305
  • Fax: 818-705-4307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPSY14261
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: