Healthcare Provider Details

I. General information

NPI: 1912928037
Provider Name (Legal Business Name): SAN FERNANDO VALLEY PULMONARY MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18399 VENTURA BLVD SUITE 245
TARZANA CA
91356-4233
US

IV. Provider business mailing address

18399 VENTURA BLVD SUITE 245
TARZANA CA
91356-4233
US

V. Phone/Fax

Practice location:
  • Phone: 818-609-7536
  • Fax: 818-344-9670
Mailing address:
  • Phone: 818-609-7536
  • Fax: 818-344-9670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: DR. THOMAS JENKINS ENCE
Title or Position: CORPORATE SECRETARY
Credential: M.D.
Phone: 818-609-7536