=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306024054
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HERBERT DUVIVIER, MD, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/05/2008
-----------------------------------------------------
Last Update Date | 06/10/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2701 W ALAMEDA AVE SUITE 303
-----------------------------------------------------
City | BURBANK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91505-4402
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-845-2405
-----------------------------------------------------
Fax | 818-845-2774
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2701 W ALAMEDA AVE SUITE 303
-----------------------------------------------------
City | BURBANK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91505-4402
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-845-2405
-----------------------------------------------------
Fax | 818-845-2774
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | HERBERT DUVIVIER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 818-845-2405
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RH0003X
-----------------------------------------------------
Taxonomy Name | Hematology & Oncology Physician
-----------------------------------------------------
License Number | G67229
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------