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General NPI Number Information
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NPI Number | 1861629222
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Entity Type | Organization
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Legal Business Name | RESEDA FAMILY MEDICINE CLINIC AND MULTI-SPECIALTY GROUP INC
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Dates
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Enumeration Date | 06/12/2009
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Last Update Date | 10/22/2024
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Provider Practice Location Address
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Address Line | 6830 RESEDA BLVD
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City | RESEDA
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State | CA
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Zip | 91335
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Country | US
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Telephone | 818-996-4888
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Fax | 818-996-5888
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Provider Business Mailing Address
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Address Line | 6830 RESEDA BLVD
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City | RESEDA
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State | CA
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Zip | 91335
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Country | US
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Telephone | 818-996-4888
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Fax | 818-996-5888
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Authorized Official
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Title or Position | CEO
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Name | DR. SYRUS FERIDOUNI
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Credential | M.D.
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Telephone | 818-744-4369
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 000242910900017
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License Number State | CA
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