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General NPI Number Information
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NPI Number | 1104955665
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Entity Type | Organization
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Legal Business Name | ALLEN T PACK MD PC
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Dates
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Enumeration Date | 03/02/2007
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Last Update Date | 07/07/2008
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Provider Practice Location Address
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Address Line | 11633 SAN VICENTE BLVD #202
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City | LOS ANGELES
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State | CA
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Zip | 90049-6511
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Country | US
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Telephone | 310-820-9123
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Fax |
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Provider Business Mailing Address
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Address Line | 11633 SAN VICENTE BLVD #202
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City | LOS ANGELES
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State | CA
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Zip | 90049-6511
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Country | US
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Telephone | 310-820-9123
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ALLEN T PACK
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Credential | MD
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Telephone | 310-820-9123
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | C34674
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License Number State | CA
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