Provider Demographics
NPI:1588071245
Name:VALLEYHOPEOUTPATIENT
Entity type:Organization
Organization Name:VALLEYHOPEOUTPATIENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:FERNANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-902-1100
Mailing Address - Street 1:14416 FRIAR ST SUITE C
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91401
Mailing Address - Country:US
Mailing Address - Phone:818-902-1100
Mailing Address - Fax:818-902-1300
Practice Address - Street 1:14416 FRIAR ST STE C
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91401-6800
Practice Address - Country:US
Practice Address - Phone:818-902-1100
Practice Address - Fax:818-902-1300
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VALLEYHOPEOUTPATIENT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-07-15
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA190803AP305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service