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General NPI Number Information
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NPI Number | 1528165149
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Entity Type | Organization
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Legal Business Name | HUMANA MEDICAL GROUP INC
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Dates
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Enumeration Date | 09/17/2006
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Last Update Date | 06/30/2015
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Provider Practice Location Address
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Address Line | 4621 RUBIO AVENUE
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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 | 818-981-0050
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Fax | 818-907-7080
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Provider Business Mailing Address
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Address Line | 4621 RUBIO AVENUE
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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 | 818-981-0050
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Fax | 818-907-7080
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Authorized Official
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Title or Position | OWNER PRESIDENT
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Name | GEORGE DANIAL
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Credential | DO
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Telephone | 818-981-0050
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 20A4720
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License Number State | CA
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