MEDICARE: ENCINO FAMILY HEALTH ASSOCIATES, 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	207QA0401X	Addiction Medicine (Family Medicine) Physician
2	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1578517033
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENCINO FAMILY HEALTH ASSOCIATES, INC

Provider Business Mailing Address
First Line	:	16661 VENTURA BLVD
Second Line	:	SUITE #820
City	:	ENCINO
State	:	CA
Zip	:	91436-1914
Country	:	US
Telephone Number	:	818-808-0037
Fax Number	:	818-808-0039

Provider Business Practice Location Address
First Line	:	16661 VENTURA BLVD
Second Line	:	SUITE #820
City	:	ENCINO
State	:	CA
Zip	:	91436-1914
Country	:	US
Telephone Number	:	818-808-0037
Fax Number	:	818-808-0039

Authorized Official
Title or Position	:	SOLE OWNER
Name	:	DR. KAMI ADIBI
Credential	:	M.D.
Telephone Number	:	818-808-0037

Provider Enumeration Date	:	05/20/2006
Last Update Date	:	03/28/2008

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