Provider Demographics
NPI:1063199255
Name:TARZANA OPTIMAL MEDICAL CENTER INC
Entity type:Organization
Organization Name:TARZANA OPTIMAL MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:DO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-962-9996
Mailing Address - Street 1:18345 VENTURA BLVD STE 202
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-4241
Mailing Address - Country:US
Mailing Address - Phone:310-962-9996
Mailing Address - Fax:747-588-5950
Practice Address - Street 1:18345 VENTURA BLVD STE 202
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-4241
Practice Address - Country:US
Practice Address - Phone:310-962-9996
Practice Address - Fax:747-588-5950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-29
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty