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General NPI Number Information
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NPI Number | 1649493271
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Entity Type | Organization
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Legal Business Name | PRIMARY CARE AND PEDIATRIC INDEPENDENT PHYSICIANS ASSOCIATION, INC.
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Dates
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Enumeration Date | 04/11/2007
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Last Update Date | 08/15/2008
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Provider Practice Location Address
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Address Line | 16030 VENTURA BLVD STE 200
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City | ENCINO
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State | CA
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Zip | 91436-2754
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Country | US
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Telephone | 818-461-5030
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Fax | 818-461-5095
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Provider Business Mailing Address
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Address Line | 16030 VENTURA BLVD STE 200
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City | ENCINO
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State | CA
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Zip | 91436-2754
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Country | US
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Telephone | 818-461-5030
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Fax | 818-461-5095
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Authorized Official
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Title or Position | COMPLIANCE OFFICER
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Name | MS. DIANE PENN
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Credential |
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Telephone | 818-461-5030
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | G86422
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License Number State | CA
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