Healthcare Provider Details

I. General information

NPI: 1710878491
Provider Name (Legal Business Name): CLIFFORD FELDMAN GROUP PRACTICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2025
Last Update Date: 07/11/2025
Certification Date: 07/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4018 ROCK HAMPTON DR
TARZANA CA
91356-5719
US

IV. Provider business mailing address

PO BOX 572109
TARZANA CA
91357-2109
US

V. Phone/Fax

Practice location:
  • Phone: 818-324-6979
  • Fax: 805-584-9651
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: KRISTA DENNIS
Title or Position: BILLING MANAGER
Credential:
Phone: 805-579-3537