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General NPI Number Information
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NPI Number | 1477746907
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Entity Type | Organization
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Legal Business Name | ROSSCOE VAN NUYS MEDICAL CLINIC, INC.
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Dates
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Enumeration Date | 08/17/2007
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Last Update Date | 08/17/2007
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Provider Practice Location Address
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Address Line | 8121 VAN NUYS BLVD STE 414
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City | PANORAMA CITY
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State | CA
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Zip | 91402-5120
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Country | US
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Telephone | 818-782-1982
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Fax | 818-782-1935
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Provider Business Mailing Address
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Address Line | 8121 VAN NUYS BLVD STE 414
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City | PANORAMA CITY
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State | CA
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Zip | 91402-5120
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Country | US
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Telephone | 818-782-1982
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Fax | 818-782-1935
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Authorized Official
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Title or Position | OVNER
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Name | DR. AIDA HAWATMEH
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Credential |
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Telephone | 818-782-1982
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | DC20620
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License Number State | CA
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