| Healthline Medical Group | |
|
15211 Vanowen St Suite 105 Van Nuys CA 91405-3606 | |
| (818) 997-7711 | |
| (818) 997-3744 |
| Full Name | Healthline Medical Group |
|---|---|
| Speciality | Internal Medicine |
| Location | 15211 Vanowen St, Van Nuys, California |
| Authorized Official Name and Position | Rita Gaudioso (ADMINISTRATOR) |
| Authorized Official Contact | 8189977711 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Healthline Medical Group 15211 Vanowen St Suite 105 Van Nuys CA 91405-3606 Ph: (818) 997-7711 | Healthline Medical Group 15211 Vanowen St Suite 105 Van Nuys CA 91405-3606 Ph: (818) 997-7711 |
| NPI Number | 1194850446 |
|---|---|
| Provider Enumeration Date | 02/23/2007 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 6800832908 |
|---|---|
| Medicare Enrollment ID | O20050629000315 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194850446 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Barry S Rosenblum |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1740361096 PECOS PAC ID: 0143256776 Enrollment ID: I20050714000379 |
| Provider Name | Emmett A Berg |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1942382007 PECOS PAC ID: 0446287700 Enrollment ID: I20050719000886 |
| Provider Name | Gary I Reyzin |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1871779769 PECOS PAC ID: 4587742044 Enrollment ID: I20080423000729 |
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