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Organization
MOTION PICTURE AND TELEVISION FUND MEDICAL GROUP
Active
Organization
MOTION PICTURE AND TELEVISION FUND MEDICAL GROUP
Active
Other names
TOLUCA LAKE HEALTH CENTER
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SETH ELLIS (VP CHIEF OPERATING OFFICER)
(818) 876-1079
Entity
Organization
Contact information
Practice address
4323 W RIVERSIDE DR, BURBANK, CA 91505-4044
(818) 556-2700
Mailing address
23388 MULHOLLAND DR, MAILSTOP 62, WOODLAND HILLS, CA 91364-2733
(818) 876-1636
(818) 876-1516
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ZZZ09389Z
BLUE SHIELD
CA
Enumeration date
07/16/2006
Last updated
02/08/2010
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