Organization
CALIFORNIA CENTER FOR HEALTHY LIVING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ELAINE ROSEN M.D. (DIRECTOR)
(818) 528-5510
Entity
Organization
Contact information
Practice address
16550 VENTURA BLVD, SUITE 401, ENCINO, CA 91436-2004
(818) 528-5510
(818) 986-1238
Mailing address
16550 VENTURA BLVD, SUITE 401, ENCINO, CA 91436-2004
(818) 528-5510
(818) 986-1238
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
PSY14195
CA
133VN1004X
Pediatric Nutrition Registered Dietitian
898967
CA
302F00000X
Exclusive Provider Organization
Primary
A50232
CA
Other
Enumeration date
11/24/2009
Last updated
11/24/2009
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