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General NPI Number Information
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NPI Number | 1437676616
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Entity Type | Organization
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Legal Business Name | MICHAEL M. KERAMATI, DO A MEDICAL CORPORATION
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Dates
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Enumeration Date | 08/28/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 16550 VENTURA BLVD STE 214
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City | ENCINO
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State | CA
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Zip | 91436-2055
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Country | US
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Telephone | 818-990-5588
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Fax |
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Provider Business Mailing Address
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Address Line | 16550 VENTURA BLVD. SUITE 214
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City | ENCINO
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State | CA
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Zip | 91436
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Country | US
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Telephone | 818-990-5588
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MISS JENNIFER CALDERON
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Credential | MA, RDA
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Telephone | 818-990-5588
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 20A8906
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License Number State | CA
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