| Tarzana Pediatric Medical Group Inc | |
|
18370 Burbank Blvd Suite #204 Tarzana CA 91356-2851 | |
| (818) 345-7792 | |
| (818) 345-9052 |
| Full Name | Tarzana Pediatric Medical Group Inc |
|---|---|
| Speciality | Pediatrics |
| Location | 18370 Burbank Blvd, Tarzana, California |
| Authorized Official Name and Position | Norman Lavin (OWNER) |
| Authorized Official Contact | 8183457792 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tarzana Pediatric Medical Group Inc 18370 Burbank Blvd Suite #204 Tarzana CA 91356-2851 Ph: (818) 345-7792 | Tarzana Pediatric Medical Group Inc 18370 Burbank Blvd Suite #204 Tarzana CA 91356-2851 Ph: (818) 345-7792 |
| NPI Number | 1033227970 |
|---|---|
| Provider Enumeration Date | 08/29/2006 |
| Last Update Date | 08/12/2014 |
| Medicare PECOS PAC ID | 9234323155 |
|---|---|
| Medicare Enrollment ID | O20101104000163 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033227970 | NPI | - | NPPES |
| G16804 | Other | CA | STATE LICENSE |
| GR0002970 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RE0101X | Internal Medicine - Endocrinology, Diabetes & Metabolism | G16804 (California) | Secondary |
| 208000000X | Pediatrics | G16804 (California) | Primary |
| Provider Name | Norman Lavin |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1811902786 PECOS PAC ID: 4284828104 Enrollment ID: I20101104000258 |
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