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General NPI Number Information
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NPI Number | 1760661110
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Entity Type | Organization
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Legal Business Name | THOMAS A HERBOLD MD A PROFETIONAL CORP
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Dates
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Enumeration Date | 11/01/2007
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Last Update Date | 11/01/2007
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Provider Practice Location Address
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Address Line | 16661 VENTURA BLVD SUITE 100
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City | ENCINO
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State | CA
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Zip | 91436-1914
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Country | US
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Telephone | 818-986-3472
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Fax | 818-760-7789
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Provider Business Mailing Address
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Address Line | 16661 VENTURA BLVD SUITE 100
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City | ENCINO
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State | CA
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Zip | 91436-1914
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Country | US
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Telephone | 818-986-3472
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Fax | 818-670-7789
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Authorized Official
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Title or Position | DIRECTOR
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Name | THOMAS ANDY HERBOLD
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Credential | M.D.
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Telephone | 818-986-3472
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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