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General NPI Number Information
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NPI Number | 1669298527
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Entity Type | Organization
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Legal Business Name | PRIDE PSYCHIATRY SERVICES
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Dates
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Enumeration Date | 11/25/2024
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Last Update Date | 11/25/2024
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Provider Practice Location Address
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Address Line | 15720 VENTURA BLVD STE 528
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City | ENCINO
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State | CA
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Zip | 91436-2936
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Country | US
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Telephone | 818-736-8642
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Fax |
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Provider Business Mailing Address
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Address Line | 15720 VENTURA BLVD STE 528
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City | ENCINO
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State | CA
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Zip | 91436-2936
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Country | US
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Telephone | 818-736-8642
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Fax |
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Authorized Official
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Title or Position | APRN
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Name | MR. ADILSON KIEFER
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Credential | APRN
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Telephone | 818-736-8642
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry 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 | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2084P0805X
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Taxonomy Name | Geriatric Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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