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General NPI Number Information
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NPI Number | 1841465622
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Entity Type | Organization
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Legal Business Name | CENTER FOR BIO-BEHAVIORAL SCIENCE MEDICAL CORPORATION
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Dates
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Enumeration Date | 04/23/2008
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Last Update Date | 04/24/2008
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Provider Practice Location Address
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Address Line | 2080 CENTURY PARK E 308
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City | LOS ANGELES
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State | CA
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Zip | 90067-2006
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Country | US
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Telephone | 310-556-0970
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Fax | 310-556-1014
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Provider Business Mailing Address
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Address Line | 2080 CENTURY PARK E 308
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City | LOS ANGELES
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State | CA
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Zip | 90067-2006
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Country | US
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Telephone | 310-556-0970
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Fax | 310-556-1014
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Authorized Official
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Title or Position | CEO/OWNER
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Name | DR. RONALD MARK PODELL
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Credential | M.D.
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Telephone | 310-556-1013
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0805X
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Taxonomy Name | Geriatric Psychiatry Physician
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License Number | G32379
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License Number State | CA
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