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General NPI Number Information
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NPI Number | 1376859694
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Entity Type | Organization
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Legal Business Name | BURBANK GENERAL MEDICAL GROUP INC
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Dates
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Enumeration Date | 08/24/2010
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Last Update Date | 08/24/2010
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Provider Practice Location Address
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Address Line | 13330 BURBANK BLVD
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City | SHERMAN OAKS
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State | CA
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Zip | 91401-5321
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Country | US
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Telephone | 818-387-6045
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Fax | 818-387-6471
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Provider Business Mailing Address
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Address Line | 13330 BURBANK BLVD
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City | SHERMAN OAKS
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State | CA
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Zip | 91401-5321
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Country | US
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Telephone | 818-387-6045
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Fax | 818-387-6471
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | DR. RUBEN S GUALBERTO
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Credential | M.D.
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Telephone | 818-387-6045
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | A32356
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License Number State | CA
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