Healthcare Provider Details

I. General information

NPI: 1255835807
Provider Name (Legal Business Name): SAN FERNANDO VALLEY COMMUNITY MENTAL HEALTH CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2018
Last Update Date: 03/09/2020
Certification Date: 03/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6464 SYLMAR AVE
VAN NUYS CA
91401-1433
US

IV. Provider business mailing address

16360 ROSCOE BLVD FL 2
VAN NUYS CA
91406-1219
US

V. Phone/Fax

Practice location:
  • Phone: 818-785-2195
  • Fax:
Mailing address:
  • Phone: 818-901-4830
  • 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: TIMOTHY RYDER
Title or Position: PRESIDENT
Credential:
Phone: 818-901-4830