Healthcare Provider Details

I. General information

NPI: 1205294014
Provider Name (Legal Business Name): ERIC KANE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2016
Last Update Date: 02/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7505 FOOTHILL BLVD
TUJUNGA CA
91042-2116
US

IV. Provider business mailing address

10237 FERNGLEN AVE APT 213
TUJUNGA CA
91042-2277
US

V. Phone/Fax

Practice location:
  • Phone: 818-353-3772
  • Fax: 818-353-3776
Mailing address:
  • Phone: 818-470-5365
  • Fax: 818-353-3776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-15-21060
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: