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Organization
TARZANA ENDOCRINE & MEDICAL GROUP
Active
Organization
TARZANA ENDOCRINE & MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GARY TANOUYE M.D. (PRESIDENT)
(818) 996-5700
Entity
Organization
Contact information
Practice address
18370 BURBANK BLVD, STE 601, TARZANA, CA 91356-2831
(818) 996-5700
(818) 996-1649
Mailing address
18370 BURBANK BLVD, STE 601, TARZANA, CA 91356-2831
(818) 996-5700
(818) 996-1649
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
CA
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
—
CA
291U00000X
Clinical Medical Laboratory
CLF298
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05D0559244
CLIA LICENSE STE 300
CA
01
—
05D0889138
CLIA LICENSE STE 601
CA
01
—
110061982
RAILROAD GROUP RENDERING
CA
01
—
19-139
DHS MEDICAL WASTE REG #
CA
01
—
19359
FICTITIOUS NAME PERMIT
CA
01
—
CAL000056694
RADIOLOGIC LICENSE
CA
01
—
CLF298
STATE LABORATORY LICENSE
CA
01
—
CPP 315971
STATE LABORATORY LICENSE SUITE 601
CA
01
—
FAC00002669
RADIATION MACHINE DEPT OF PUBLIC HEALTH, CALIF.
CA
01
—
T0796
RAILROAD GROUP NUMBER
CA
01
—
YYY40048Y
BLUE SHIELD OF CALIFORNIA
CA
05
—
YYY40048Y
—
CA
Enumeration date
06/14/2005
Last updated
07/21/2022
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