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General NPI Number Information
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NPI Number | 1952407975
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Entity Type | Organization
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Legal Business Name | VERDUGO MEDICAL GROUP, INC
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Dates
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Enumeration Date | 09/16/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1508 W VERDUGO AVE STE C
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City | BURBANK
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State | CA
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Zip | 91506-2446
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Country | US
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Telephone | 818-954-0208
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Fax | 818-954-0029
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Provider Business Mailing Address
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Address Line | 1508 W VERDUGO AVE STE C
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City | BURBANK
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State | CA
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Zip | 91506-2446
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Country | US
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Telephone | 818-954-0208
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Fax | 818-954-0029
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Authorized Official
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Title or Position | PRESIDENT
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Name | MEHMET KASIM
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Credential | M.D.
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Telephone | 818-954-0208
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | A31823
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 00A334650
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License Number State | CA
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