Healthcare Provider Details

I. General information

NPI: 1336572734
Provider Name (Legal Business Name): LANA D LOUIE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2013
Last Update Date: 12/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18370 BURBANK SUITE 607
TARZANA CA
91356-2833
US

IV. Provider business mailing address

PO BOX 571268 SUITE 607
TARZANA CA
91357-1268
US

V. Phone/Fax

Practice location:
  • Phone: 818-342-2123
  • Fax: 818-342-2141
Mailing address:
  • Phone: 818-257-3750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: LANA D LOUIE
Title or Position: M.D.
Credential: M.D.
Phone: 818-257-3750