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General NPI Number Information
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NPI Number | 1922233105
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Entity Type | Organization
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Legal Business Name | MA KOYLE INC
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Dates
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Enumeration Date | 05/18/2009
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Last Update Date | 05/18/2009
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Provider Practice Location Address
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Address Line | 4924 BALBOA BLVD SUITE 138
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City | ENCINO
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State | CA
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Zip | 91316-3402
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Country | US
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Telephone | 818-212-9943
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Fax |
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Provider Business Mailing Address
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Address Line | 4924 BALBOA BLVD SUITE 138
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City | ENCINO
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State | CA
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Zip | 91316-3402
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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 | CEO
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Name | MARTIN A KOYLE
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Credential |
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Telephone | 818-212-9943
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number |
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License Number State | CA
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