Healthcare Provider Details

I. General information

NPI: 1427494079
Provider Name (Legal Business Name): RENITA PULLENS DO A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2013
Last Update Date: 05/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16600 SHERMAN WAY SUITE 266
VAN NUYS CA
91406-3875
US

IV. Provider business mailing address

16600 SHERMAN WAY SUITE 266
VAN NUYS CA
91406-3875
US

V. Phone/Fax

Practice location:
  • Phone: 818-779-0120
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: RENITA PULLENS
Title or Position: PRESIDENT
Credential: DO
Phone: 562-299-5239