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General NPI Number Information
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NPI Number | 1699152850
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Entity Type | Organization
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Legal Business Name | DR. ALLAN BOODNICK
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Dates
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Enumeration Date | 04/27/2015
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Last Update Date | 04/27/2015
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Provider Practice Location Address
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Address Line | 5301 LADERA CREST DR
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City | LOS ANGELES
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State | CA
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Zip | 90056-1152
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Country | US
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Telephone | 310-337-7200
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Fax |
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Provider Business Mailing Address
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Address Line | 5301 LADERA CREST DR
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City | LOS ANGELES
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State | CA
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Zip | 90056-1152
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Country | US
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Telephone | 310-337-7200
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Fax |
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Authorized Official
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Title or Position | MFT
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Name | DR. ALLAN BOODNICK
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Credential |
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Telephone | 310-337-7200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | MFT 2015
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License Number State | CA
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