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General NPI Number Information
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NPI Number | 1356877740
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Entity Type | Organization
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Legal Business Name | CALABASAS PEDIATRICS
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Dates
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Enumeration Date | 05/04/2017
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Last Update Date | 05/04/2017
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Provider Practice Location Address
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Address Line | 23480 PARK SORRENTO SUITE 109A
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City | CALABASAS
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State | CA
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Zip | 91302-1306
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Country | US
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Telephone | 818-914-4429
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Fax |
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Provider Business Mailing Address
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Address Line | 23480 PARK SORRENTO SUITE 109A
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City | CALABASAS
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State | CA
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Zip | 91302-1306
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Country | US
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Telephone | 818-914-4429
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Fax |
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Authorized Official
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Title or Position | PEDIATRICIAN
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Name | DR. TANYA ALTMANN
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Credential | MD
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Telephone | 818-914-4429
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | A72521
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License Number State | CA
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