Provider Demographics
NPI:1366470437
Name:ENCINO MEDICAL WELLNESS CENTER
Entity Type:Organization
Organization Name:ENCINO MEDICAL WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:ROSENBLATT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-990-6222
Mailing Address - Street 1:16250 VENTURA BLVD
Mailing Address - Street 2:SUITE 160
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2204
Mailing Address - Country:US
Mailing Address - Phone:818-990-6222
Mailing Address - Fax:818-990-6217
Practice Address - Street 1:16250 VENTURA BLVD
Practice Address - Street 2:SUITE 160
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2204
Practice Address - Country:US
Practice Address - Phone:818-990-6222
Practice Address - Fax:818-990-6217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty