Healthcare Provider Details

I. General information

NPI: 1558692103
Provider Name (Legal Business Name): PHILIP F MECHAEL PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/21/2010
Last Update Date: 01/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6815 NOBLE AVE
VAN NUYS CA
91405-3796
US

IV. Provider business mailing address

6815 NOBLE AVE
VAN NUYS CA
91405-3796
US

V. Phone/Fax

Practice location:
  • Phone: 818-901-6600
  • Fax: 818-997-7826
Mailing address:
  • Phone: 818-901-6600
  • Fax: 818-997-7826

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA20683
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: