Healthcare Provider Details

I. General information

NPI: 1669584801
Provider Name (Legal Business Name): LLORENS JOSEPH PEMBROOK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 12/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15107 VANOWEN ST
VAN NUYS CA
91405-4542
US

IV. Provider business mailing address

24696 GILMORE ST
WEST HILLS CA
91307-2723
US

V. Phone/Fax

Practice location:
  • Phone: 818-902-2919
  • Fax: 818-902-5797
Mailing address:
  • Phone: 310-739-1127
  • Fax: 818-436-2322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PH0002X
TaxonomyHospice and Palliative Medicine (Emergency Medicine) Physician
License NumberA37585
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: