Organization
VIDA'S GALLERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHERVIN SHAMTOUB D.P.M. (SOLE OWNER)
(818) 342-7017
Entity
Organization
Contact information
Practice address
18345 VANOWEN ST, SUITE 'H', RESEDA, CA 91335-5439
(818) 342-7017
Mailing address
5231 ZELZAH AVE, ENCINO, CA 91316-2121
(818) 416-2919
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
EXAMPED O/P
CA
Other
Enumeration date
05/20/2006
Last updated
08/27/2008
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