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18663 Ventura Blvd Ste 120 Tarzana CA 91356-6806 | |
| (310) 775-3388 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 18663 Ventura Blvd Ste 120, Tarzana, California |
| Authorized Official Name and Position | Beth Meneley (OWNER) |
| Authorized Official Contact | 3107753388 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
18663 Ventura Blvd Ste 120 Tarzana CA 91356-6806 Ph: (310) 775-3388 | 18663 Ventura Blvd Ste 120 Tarzana CA 91356-6806 Ph: (310) 775-3388 |
| NPI Number | 1023716552 |
|---|---|
| Provider Enumeration Date | 02/23/2023 |
| Last Update Date | 12/13/2024 |
| Medicare PECOS PAC ID | 6901268200 |
|---|---|
| Medicare Enrollment ID | O20230818000854 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023716552 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Christine Lori Rongey |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1033403647 PECOS PAC ID: 9739472721 Enrollment ID: I20170928003344 |
| Provider Name | Lexus Marie Rogers |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114561826 PECOS PAC ID: 9133575509 Enrollment ID: I20231023000720 |
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