Healthcare Provider Details

I. General information

NPI: 1164427316
Provider Name (Legal Business Name): SAN FERNANDO VALLEY COMMUNITY MENTAL HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2005
Last Update Date: 10/18/2023
Certification Date: 10/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16360 ROSCOE BLVD 2ND FLOOR
VAN NUYS CA
91406-1219
US

IV. Provider business mailing address

16360 ROSCOE BLVD 2ND FLOOR
VAN NUYS CA
91406-1219
US

V. Phone/Fax

Practice location:
  • Phone: 818-901-4830
  • Fax: 818-785-3446
Mailing address:
  • Phone: 818-901-4830
  • Fax: 818-785-3446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberD0591483
License Number StateCA

VIII. Authorized Official

Name: TIMOTHY RYDER
Title or Position: PRESIDENT
Credential:
Phone: 818-901-4830