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General NPI Number Information
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NPI Number | 1316568348
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Entity Type | Organization
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Legal Business Name | INLE MEDICAL GROUP
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Dates
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Enumeration Date | 04/30/2020
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Last Update Date | 04/30/2020
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Provider Practice Location Address
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Address Line | 23586 CALABASAS RD STE 107
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City | CALABASAS
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State | CA
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Zip | 91302-1334
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Country | US
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Telephone | 323-457-4541
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 573304
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City | TARZANA
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State | CA
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Zip | 91357-3304
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Country | US
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Telephone | 323-457-4541
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JONATHAN PRINCE
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Credential | MD
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Telephone | 646-528-3261
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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 |
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License Number State |
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