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General NPI Number Information
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NPI Number | 1881616928
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Entity Type | Organization
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Legal Business Name | BURBANK EAST VALLEY MEDICAL GROUP
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Dates
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Enumeration Date | 07/25/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 201 S BUENA VISTA ST 3RD FLOOR
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City | BURBANK
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State | CA
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Zip | 91505-4569
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Country | US
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Telephone | 818-842-7145
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Fax | 818-842-8279
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Provider Business Mailing Address
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Address Line | PO BOX 10240
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City | CANOGA PARK
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State | CA
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Zip | 91309-1240
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Country | US
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Telephone | 818-704-4301
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Fax | 818-704-9392
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Authorized Official
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Title or Position | M.D.
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Name | MICHAEL MARSH
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Credential |
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Telephone | 818-842-7145
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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