Organization
MOTION PICTURE AND TELEVISION FUND MEDICAL GROUP INC
Active
Other names
CENTER ON AGING
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
23388 MULHOLLAND DR, MAILSTOP 260, WOODLAND HILLS, CA 91364-2733
(818) 876-1636
Mailing address
23388 MULHOLLAND DR, MAILSTOP 260, WOODLAND HILLS, CA 91364-2733
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
—
—
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ZZZ09390Z
BLUE SHIELD
CA
Enumeration date
07/02/2007
Last updated
02/08/2010
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