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
1	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1518764190
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 STE 200
Second Line	:
City	:	VAN NUYS
State	:	CA
Zip	:	91406-1213
Country	:	US
Telephone Number	:	818-901-4830
Fax Number	:

Provider Business Practice Location Address
First Line	:	6501 BALBOA BLVD
Second Line	:
City	:	LAKE BALBOA
State	:	CA
Zip	:	91406-5526
Country	:	US
Telephone Number	:	818-901-4830
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	TIMOTHY RYDER
Credential	:
Telephone Number	:	818-901-4830

Provider Enumeration Date	:	02/28/2025
Last Update Date	:	03/04/2025

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