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13143 Bassett St North Hollywood CA 91605-4726 | |
| (818) 901-4830 | |
| (818) 785-3446 |
| Full Name | |
|---|---|
| Speciality | Psychiatry & Neurology - Psychiatry |
| Location | 13143 Bassett St, North Hollywood, California |
| Authorized Official Name and Position | Timothy Ryder (PRESIDENT) |
| Authorized Official Contact | 8189014830 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
16360 Roscoe Blvd Suite 200 Van Nuys CA 91406-1219 Ph: (818) 901-4830 | 13143 Bassett St North Hollywood CA 91605-4726 Ph: (818) 901-4830 |
| NPI Number | 1750411609 |
|---|---|
| Provider Enumeration Date | 03/07/2007 |
| Last Update Date | 03/09/2020 |
| Certification Date | 03/09/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750411609 | NPI | - | NPPES |
| 000007415 | Other | CA | MEDICAL PROVIDER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | D0591483 (California) | Primary |
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