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General NPI Number Information
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NPI Number | 1639604028
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Entity Type | Organization
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Legal Business Name | HEAD BUGS INC.
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Dates
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Enumeration Date | 04/24/2017
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Last Update Date | 04/24/2017
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Provider Practice Location Address
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Address Line | 5353 BALBOA BLVD SUITE 100
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City | ENCINO
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State | CA
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Zip | 91316-2804
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Country | US
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Telephone | 747-225-8334
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Fax |
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Provider Business Mailing Address
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Address Line | 5353 BALBOA BLVD SUITE 100
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City | ENCINO
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State | CA
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Zip | 91316-2804
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Country | US
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Telephone | 747-225-8334
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. MATTHEW ANDREW RILEY
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Credential |
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Telephone | 747-225-8334
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 247200000X
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Taxonomy Name | Other Technician
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License Number |
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License Number State |
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