=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356792394
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MEND MEDICAL INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/30/2016
-----------------------------------------------------
Last Update Date | 07/12/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4312 WOODMAN AVE SUITE 102
-----------------------------------------------------
City | SHERMAN OAKS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91423-5546
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-488-2830
-----------------------------------------------------
Fax | 888-502-9285
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4312 WOODMAN AVE SUITE 102
-----------------------------------------------------
City | SHERMAN OAKS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91423-5546
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-488-2830
-----------------------------------------------------
Fax | 888-502-9285
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. ANTHONY CARDILLO
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 310-488-2830
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | A82516
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------