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General NPI Number Information
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NPI Number | 1487753216
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Entity Type | Organization
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Legal Business Name | WOMENS HEALTH MEDICAL GROUP
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Dates
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Enumeration Date | 09/21/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3469 N VERDUGO RD
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City | GLENDALE
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State | CA
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Zip | 91208
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Country | US
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Telephone | 818-249-6636
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Fax | 818-249-5074
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Provider Business Mailing Address
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Address Line | 3469 N VERDUGO RD
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City | GLENDALE
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State | CA
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Zip | 91208
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Country | US
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Telephone | 818-249-6636
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Fax | 818-249-5074
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | MRS. KOLLEEN OBANNON SQUIRES
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Credential | CNP
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Telephone | 818-249-6636
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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