Healthcare Provider Details

I. General information

NPI: 1215918800
Provider Name (Legal Business Name): HEATHER JOY SHENKMAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 07/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18663 VENTURA BLVD STE 202
TARZANA CA
91356
US

IV. Provider business mailing address

18663 VENTURA BLVD STE 202
TARZANA CA
91356-4151
US

V. Phone/Fax

Practice location:
  • Phone: 818-938-9505
  • Fax: 818-938-9513
Mailing address:
  • Phone: 818-938-9505
  • Fax: 818-938-9513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberA98800
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: