=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164561239
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | YANIV FARBENBLOOM D.C.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/06/2007
-----------------------------------------------------
Last Update Date | 04/25/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16133 VENTURA BLVD STE 700
-----------------------------------------------------
City | ENCINO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91436-2406
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-377-7444
-----------------------------------------------------
Fax | 415-634-1356
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16133 VENTURA BLVD STE 700
-----------------------------------------------------
City | ENCINO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91436-2406
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-377-7444
-----------------------------------------------------
Fax | 415-634-1356
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111NS0005X
-----------------------------------------------------
Taxonomy Name | Sports Physician Chiropractor
-----------------------------------------------------
License Number | 25863
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------