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General NPI Number Information
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NPI Number | 1710256086
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Entity Type | Organization
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Legal Business Name | WOODVIC MEDICAL CARE AND CLINIC
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Dates
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Enumeration Date | 12/15/2011
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Last Update Date | 12/15/2011
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Provider Practice Location Address
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Address Line | 13653 VICTORY BLVD
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City | VAN NUYS
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State | CA
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Zip | 91401-1735
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Country | US
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Telephone | 818-988-9825
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Fax | 818-988-9305
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Provider Business Mailing Address
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Address Line | 13653 VICTORY BLVD
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City | VAN NUYS
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State | CA
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Zip | 91401-1735
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Country | US
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Telephone | 818-988-9825
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Fax | 818-988-9305
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | DR. STEVEN ROSENBLATT
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Credential | MD
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Telephone | 818-988-9825
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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