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4323 W Riverside Dr Burbank CA 91505-4044 | |
| (818) 556-2700 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Internal Medicine |
| Location | 4323 W Riverside Dr, Burbank, California |
| Authorized Official Name and Position | Seth Ellis (VP CHIEF OPERATING OFFICER) |
| Authorized Official Contact | 8188761079 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
23388 Mulholland Dr Mailstop 62 Woodland Hills CA 91364-2733 Ph: (818) 876-1636 | 4323 W Riverside Dr Burbank CA 91505-4044 Ph: (818) 556-2700 |
| NPI Number | 1396762100 |
|---|---|
| Provider Enumeration Date | 07/16/2006 |
| Last Update Date | 02/08/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396762100 | NPI | - | NPPES |
| ZZZ09389Z | Other | CA | BLUE SHIELD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| 363L00000X | Nurse Practitioner | (* (Not Available)) | Secondary |
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