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General NPI Number Information
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NPI Number | 1467724732
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Entity Type | Organization
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Legal Business Name | BLUEBERRY MEDICAL
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Dates
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Enumeration Date | 02/02/2012
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Last Update Date | 02/02/2012
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Provider Practice Location Address
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Address Line | 5400 BALBOA BLVD
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City | ENCINO
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State | CA
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Zip | 91316-1502
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Country | US
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Telephone | 818-789-0203
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Fax |
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Provider Business Mailing Address
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Address Line | 16628 OAK VIEW CT
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City | ENCINO
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State | CA
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Zip | 91436-1900
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Country | US
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Telephone | 310-989-1892
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Fax |
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Authorized Official
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Title or Position | FOUNDER
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Name | DR. MARJORIE YONG
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Credential | MD
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Telephone | 310-989-1892
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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 |
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License Number State |
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