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NPI Code Detail

MEDICARE: SAN FERNANDO VALLEY COMMUNITY MENTAL HEALTH CENTER, INC.

MEDICARE: SAN FERNANDO VALLEY COMMUNITY MENTAL HEALTH CENTER, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084P0800XPsychiatry PhysicianD0591483CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1000007235OTHERCAMEDICAL PROVIDER

General Provider Information

NPI Number : 1013047281
Entity Type Code : Organization
Provider Name (Legal Business Name) : SAN FERNANDO VALLEY COMMUNITY MENTAL HEALTH CENTER, INC.
Provider Business Mailing Address
First Line : 16360 ROSCOE BLVD
Second Line : SUITE 200
City : VAN NUYS
State : CA
Zip : 91406-1219
Country : US
Telephone Number : 818-901-4830
Fax Number : 818-785-3446
Provider Business Practice Location Address
First Line : 6501 VAN NUYS BLVD # 102
Second Line :
City : VAN NUYS
State : CA
Zip : 91401-1425
Country : US
Telephone Number : 818-989-7475
Fax Number : 818-781-3822
Authorized Official
Title or Position : PRESIDENT
Name : TIMOTHY RYDER
Credential :
Telephone Number : 818-901-4830
Provider Enumeration Date : 03/06/2007
Last Update Date : 08/25/2025

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Directions to “SAN FERNANDO VALLEY COMMUNITY MENTAL HEALTH CENTER, INC. ” Practice Location

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