Organization
MID VALLEY DERMATOLOGY
Active
Organization
MID VALLEY DERMATOLOGY
Active
Other names
ALLAN S WIRTZER MD
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ROCELYN LUCAS TAYLOR (BILLING SUPERVISOR)
(818) 907-7546
Entity
Organization
Contact information
Practice address
4836 VAN NUYS BLVD, SHERMAN OAKS, CA 91403-2101
(818) 907-7546
(818) 907-9506
Mailing address
4836 VAN NUYS BLVD, SHERMAN OAKS, CA 91403-2101
(818) 907-7546
(818) 907-9506
Taxonomy
Speciality
Code
Description
License number
State
207NS0135X
Procedural Dermatology Physician
Primary
G21007
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1326003161
ALLAN S. WIRTZER, MD, MEDICAL DIRECTOR NPI#
CA
01
—
A41138
ALLAN S. WIRTZER, MD, MEDICAL DIRECTOR UPIN#
CA
01
—
G21007
ALLAN S. WIRTZER, MD, MEDICAL DIRECTOR ,CA LIC#
CA
Enumeration date
06/21/2007
Last updated
11/11/2008
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