Healthcare Provider Details

I. General information

NPI: 1841622206
Provider Name (Legal Business Name): MY CHOICE IPA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2013
Last Update Date: 08/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6400 CANOGA AVE SUITE 163
WOODLAND HILLS CA
91367-2425
US

IV. Provider business mailing address

6400 CANOGA AVE SUITE 163
WOODLAND HILLS CA
91367-2425
US

V. Phone/Fax

Practice location:
  • Phone: 818-702-0100
  • Fax: 818-702-9128
Mailing address:
  • Phone: 818-702-0100
  • Fax: 818-702-9128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MS. KIMBERLY CAREY
Title or Position: ADMINISTRATOR
Credential:
Phone: 818-702-0100