Healthcare Provider Details

I. General information

NPI: 1689156275
Provider Name (Legal Business Name): ENDOCRINE SPECIALTY CONSULTANT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2018
Last Update Date: 09/28/2023
Certification Date: 09/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4418 VINELAND AVE STE 102
TOLUCA LAKE CA
91602-3457
US

IV. Provider business mailing address

4418 VINELAND AVE STE 102
NORTH HOLLYWOOD CA
91602-3457
US

V. Phone/Fax

Practice location:
  • Phone: 818-239-0299
  • Fax: 818-514-2374
Mailing address:
  • Phone: 818-239-0299
  • Fax: 818-514-2374

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberA55349
License Number StateCA

VIII. Authorized Official

Name: MINH MACH
Title or Position: PRESIDENT
Credential: MD
Phone: 818-239-0299