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General NPI Number Information
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NPI Number | 1629306089
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Entity Type | Organization
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Legal Business Name | CALIFORNIA CENTER FOR HEALTHY LIVING
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Dates
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Enumeration Date | 11/24/2009
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Last Update Date | 11/24/2009
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Provider Practice Location Address
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Address Line | 16550 VENTURA BLVD SUITE 401
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City | ENCINO
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State | CA
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Zip | 91436-2004
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Country | US
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Telephone | 818-528-5510
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Fax | 818-986-1238
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Provider Business Mailing Address
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Address Line | 16550 VENTURA BLVD SUITE 401
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City | ENCINO
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State | CA
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Zip | 91436-2004
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Country | US
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Telephone | 818-528-5510
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Fax | 818-986-1238
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. ELAINE ROSEN
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Credential | M.D.
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Telephone | 818-528-5510
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY14195
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 133VN1004X
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Taxonomy Name | Pediatric Nutrition Registered Dietitian
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License Number | 898967
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | A50232
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License Number State | CA
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