Organization
NEIL D. FAGEN,M.D.,INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NEIL D FAGEN M.D. (PRESIDENT)
(818) 996-4796
Entity
Organization
Contact information
Practice address
18411 CLARK ST, 204, TARZANA, CA 91356-3535
(818) 996-4796
(818) 996-4793
Mailing address
18411 CLARK ST, 204, TARZANA, CA 91356-3535
(818) 996-4796
(818) 996-4793
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G293040
—
CA
Enumeration date
12/13/2010
Last updated
12/13/2010
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