Healthcare Provider Details

I. General information

NPI: 1790164036
Provider Name (Legal Business Name): ARIELLE CZERWINSKI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2015
Last Update Date: 07/01/2020
Certification Date: 07/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18321 CLARK ST
TARZANA CA
91356-3501
US

IV. Provider business mailing address

505 S MAIN ST SUITE 525
ORANGE CA
92868-4509
US

V. Phone/Fax

Practice location:
  • Phone: 818-881-0800
  • Fax:
Mailing address:
  • Phone: 714-456-5631
  • Fax: 714-285-0389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number146136
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: