| Mordo Suchov M D Inc | |
|
16260 Ventura Blvd Suite Ll-15 Encino CA 91436-2203 | |
| (818) 905-1567 | |
| (818) 905-7406 |
| Full Name | Mordo Suchov M D Inc |
|---|---|
| Speciality | Internal Medicine |
| Location | 16260 Ventura Blvd, Encino, California |
| Authorized Official Name and Position | Mordo Suchov (OWNER) |
| Authorized Official Contact | 8189051567 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mordo Suchov M D Inc 16260 Ventura Blvd Suite Ll-15 Encino CA 91436-2203 Ph: (818) 905-1567 | Mordo Suchov M D Inc 16260 Ventura Blvd Suite Ll-15 Encino CA 91436-2203 Ph: (818) 905-1567 |
| NPI Number | 1306073994 |
|---|---|
| Provider Enumeration Date | 06/22/2009 |
| Last Update Date | 05/04/2023 |
| Medicare PECOS PAC ID | 8426102112 |
|---|---|
| Medicare Enrollment ID | O20090814000215 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306073994 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0100X | Internal Medicine - Gastroenterology | A39778 (California) | Primary |
| Provider Name | Maria D Ronquillo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518032762 PECOS PAC ID: 4688646318 Enrollment ID: I20040811001422 |
| Provider Name | Mordo Suchov |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1609941301 PECOS PAC ID: 7315091006 Enrollment ID: I20090814000377 |
| Provider Name | Victoria Diane De Felice |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134589088 PECOS PAC ID: 1951691047 Enrollment ID: I20160601002511 |
| Provider Name | Anastasia Andrew |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497270987 PECOS PAC ID: 3173883543 Enrollment ID: I20180202000444 |
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