Healthcare Provider Details

I. General information

NPI: 1205831583
Provider Name (Legal Business Name): TARZANA ENDOCRINE & MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18370 BURBANK BLVD STE 601
TARZANA CA
91356-2831
US

IV. Provider business mailing address

18370 BURBANK BLVD STE 601
TARZANA CA
91356-2831
US

V. Phone/Fax

Practice location:
  • Phone: 818-996-5700
  • Fax: 818-996-1649
Mailing address:
  • Phone: 818-996-5700
  • Fax: 818-996-1649

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License NumberCLF298
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateCA

VIII. Authorized Official

Name: DR. GARY TANOUYE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 818-996-5700