Healthcare Provider Details

I. General information

NPI: 1013942622
Provider Name (Legal Business Name): MOTION PICTURE AND TELEVISION FUND MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 02/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23388 MULHOLLAND DR MAILSTOP 22
WOODLAND HILLS CA
91364-2733
US

IV. Provider business mailing address

23388 MULHOLLAND DR MAILSTOP 62
WOODLAND HILLS CA
91364-2733
US

V. Phone/Fax

Practice location:
  • Phone: 818-876-1636
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. SETH ELLIS
Title or Position: VP CHIEF OPERATING OFFICER
Credential:
Phone: 818-876-1079