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General NPI Number Information
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NPI Number | 1225730716
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Entity Type | Organization
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Legal Business Name | VERDUGO MEDICAL CLINIC A PROFESSIONAL MEDICAL CORPORATION
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Dates
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Enumeration Date | 03/20/2023
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Last Update Date | 04/28/2023
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Provider Practice Location Address
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Address Line | 290 E VERDUGO AVE STE 105
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City | BURBANK
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State | CA
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Zip | 91502-1331
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Country | US
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Telephone | 818-433-7323
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Fax | 818-433-7347
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Provider Business Mailing Address
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Address Line | 290 E VERDUGO AVE STE 105
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City | BURBANK
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State | CA
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Zip | 91502-1331
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Country | US
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Telephone | 818-433-7323
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Fax | 818-433-7347
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Authorized Official
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Title or Position | PRESIDENT/NP
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Name | DR. BERNADETTE DE LARA GUIA
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Credential | NP
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Telephone | 818-433-7323
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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