Provider Demographics
NPI:1235641887
Name:PEDIATRIC AND FAMILY MEDICAL CENTER
Entity Type:Organization
Organization Name:PEDIATRIC AND FAMILY MEDICAL CENTER
Other - Org Name:EISNER HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:WARREN
Authorized Official - Middle Name:
Authorized Official - Last Name:BRODINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-747-5542
Mailing Address - Street 1:15477 VENTURA BLVD UNIT LOWER
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-3006
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15477 VENTURA BLVD UNIT LOWER
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-3006
Practice Address - Country:US
Practice Address - Phone:818-907-0322
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PEDIATRIC AND FAMILY MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-11-03
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental