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Organization
TARZANA PEDIATRIC MEDICAL GROUP INC
Active
Organization
TARZANA PEDIATRIC MEDICAL GROUP INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NORMAN LAVIN MD (OWNER)
(818) 345-7792
Entity
Organization
Contact information
Practice address
18370 BURBANK BLVD, SUITE #204, TARZANA, CA 91356-2851
(818) 345-7792
(818) 345-9052
Mailing address
18370 BURBANK BLVD, SUITE #204, TARZANA, CA 91356-2851
(818) 345-7792
(818) 345-9052
Taxonomy
Speciality
Code
Description
License number
State
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
G16804
CA
208000000X
Pediatrics Physician
Primary
G16804
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
G16804
STATE LICENSE
CA
05
—
GR0002970
—
CA
Enumeration date
08/29/2006
Last updated
08/12/2014
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