Healthcare Provider Details

I. General information

NPI: 1578705711
Provider Name (Legal Business Name): PAKULA MEDICAL A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2009
Last Update Date: 04/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6815 NOBLE AVE STE. 400
VAN NUYS CA
91405-3796
US

IV. Provider business mailing address

PO BOX 7001
TARZANA CA
91357-7001
US

V. Phone/Fax

Practice location:
  • Phone: 818-901-6690
  • Fax: 818-901-6699
Mailing address:
  • Phone: 818-888-7815
  • Fax: 818-715-1722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberG61674
License Number StateCA

VIII. Authorized Official

Name: BRADLEY PAKULA
Title or Position: PRESIDENT
Credential: MD
Phone: 818-888-7815