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General NPI Number Information
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NPI Number | 1588028625
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Entity Type | Organization
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Legal Business Name | SHERMAN OAKS INTEGRATED MEDICAL GROUP, INC.
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Dates
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Enumeration Date | 04/05/2016
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Last Update Date | 04/03/2017
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Provider Practice Location Address
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Address Line | 4835 VAN NUYS BLVD SUITE 105
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City | SHERMAN OAKS
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State | CA
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Zip | 91403-2109
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Country | US
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Telephone | 818-786-5985
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Fax | 818-786-6849
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Provider Business Mailing Address
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Address Line | 4835 VAN NUYS BLVD SUITE 105
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City | SHERMAN OAKS
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State | CA
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Zip | 91403-2109
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Country | US
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Telephone | 818-786-5985
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Fax | 818-786-6849
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Authorized Official
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Title or Position | MINORITY OWNER
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Name | BRYCE MATTHEWS
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Credential |
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Telephone | 818-786-5985
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | A102275
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License Number State | CA
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