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General NPI Number Information
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NPI Number | 1033227970
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Entity Type | Organization
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Legal Business Name | TARZANA PEDIATRIC MEDICAL GROUP INC
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Dates
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Enumeration Date | 08/29/2006
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Last Update Date | 08/12/2014
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Provider Practice Location Address
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Address Line | 18370 BURBANK BLVD SUITE #204
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City | TARZANA
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State | CA
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Zip | 91356-2851
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Country | US
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Telephone | 818-345-7792
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Fax | 818-345-9052
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Provider Business Mailing Address
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Address Line | 18370 BURBANK BLVD SUITE #204
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City | TARZANA
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State | CA
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Zip | 91356-2851
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Country | US
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Telephone | 818-345-7792
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Fax | 818-345-9052
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Authorized Official
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Title or Position | OWNER
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Name | NORMAN LAVIN
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Credential | MD
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Telephone | 818-345-7792
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | G16804
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | G16804
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License Number State | CA
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