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General NPI Number Information
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NPI Number | 1073615233
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Entity Type | Organization
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Legal Business Name | TARZANA GARDEN OB GYN
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Dates
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Enumeration Date | 09/01/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 18411 CLARK ST 301
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City | TARZANA
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State | CA
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Zip | 91356
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Country | US
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Telephone | 818-345-6600
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Fax | 818-705-0035
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Provider Business Mailing Address
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Address Line | 18411 CLARK ST 301
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City | TARZANA
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State | CA
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Zip | 91356
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Country | US
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Telephone | 818-345-6600
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Fax | 818-705-0035
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. SID KAMRAVA
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Credential | MD
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Telephone | 818-345-6650
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | A34548
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | G41227
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License Number State | CA
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