# VIDA'S GALLERY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1548214794
- **Authorized official:** DR. SHERVIN SHAMTOUB D.P.M. (SOLE OWNER)
- **Authorized official phone:** (818) 342-7017

## Contact information

- **Practice address:** 18345 VANOWEN ST, SUITE 'H', RESEDA, CA 91335-5439
- **Practice address phone:** (818) 342-7017
- **Mailing address:** 5231 ZELZAH AVE, ENCINO, CA 91316-2121
- **Mailing address phone:** (818) 416-2919

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | EXAMPED O/P | CA | Yes |

## Other

- **Enumeration date:** 05/20/2006
- **Last updated:** 08/27/2008