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General NPI Number Information
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NPI Number | 1811141021
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Entity Type | Organization
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Legal Business Name | SOUTHLANDS MEDICAL CLINIC
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Dates
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Enumeration Date | 11/14/2008
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Last Update Date | 11/14/2008
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Provider Practice Location Address
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Address Line | 8614 VAN NUYS BLVD
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City | PANORAMA CITY
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State | CA
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Zip | 91402-2913
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Country | US
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Telephone | 818-913-9551
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Fax | 818-647-6310
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Provider Business Mailing Address
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Address Line | 17171 ROSCOE BLVD SUITE F215
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City | NORTHRIDGE
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State | CA
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Zip | 91325-4060
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PADMAJA REDDY KANKAR
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Credential | MD
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Telephone | 818-913-9551
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | A 98001
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License Number State | CA
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