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General NPI Number Information
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NPI Number | 1578897831
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Entity Type | Organization
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Legal Business Name | HEALTHYLIVING MEDICAL CENTER, PC
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Dates
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Enumeration Date | 09/18/2009
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Last Update Date | 09/18/2009
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Provider Practice Location Address
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Address Line | 3513 WESTFALL DR
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City | ENCINO
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State | CA
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Zip | 91436-4151
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Country | US
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Telephone | 630-947-2896
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Fax | 818-387-8816
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Provider Business Mailing Address
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Address Line | 3513 WESTFALL DR
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City | ENCINO
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State | CA
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Zip | 91436-4151
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Country | US
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Telephone | 630-947-2896
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Fax | 818-387-8816
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Authorized Official
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Title or Position | OWNER
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Name | DR. THEODORE ENGELMANN
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Credential | DO
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Telephone | 630-947-2896
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 20A10907
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License Number State | CA
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