Provider Demographics
NPI:1063926848
Name:HEATHER SHENKMAN MEDICAL CORPORATION
Entity type:Organization
Organization Name:HEATHER SHENKMAN MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:JOY
Authorized Official - Last Name:SHENKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-938-9505
Mailing Address - Street 1:18663 VENTURA BLVD STE 202
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-4151
Mailing Address - Country:US
Mailing Address - Phone:818-497-7857
Mailing Address - Fax:818-350-0555
Practice Address - Street 1:18663 VENTURA BLVD STE 202
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-4151
Practice Address - Country:US
Practice Address - Phone:818-938-9505
Practice Address - Fax:818-938-9513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-30
Last Update Date:2017-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA98800207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty