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General NPI Number Information
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NPI Number | 1093512360
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Entity Type | Organization
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Legal Business Name | NOHO WEST MEDICAL GROUP, INC.
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Dates
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Enumeration Date | 02/25/2025
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Last Update Date | 02/25/2025
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Provider Practice Location Address
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Address Line | 12511 OXNARD ST UNIT A
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City | NORTH HOLLYWOOD
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State | CA
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Zip | 91606-4458
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Country | US
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Telephone | 818-745-8845
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Fax | 818-745-8835
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Provider Business Mailing Address
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Address Line | 12511 OXNARD ST UNIT A
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City | NORTH HOLLYWOOD
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State | CA
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Zip | 91606-4458
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Country | US
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Telephone | 818-745-8845
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Fax | 818-745-8835
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | MARIBETH FLORESTA MCKINNEY
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Credential | DNP
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Telephone | 818-745-7745
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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