Provider Demographics
NPI:1376859694
Name:BURBANK GENERAL MEDICAL GROUP INC
Entity Type:Organization
Organization Name:BURBANK GENERAL MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:RUBEN
Authorized Official - Middle Name:S
Authorized Official - Last Name:GUALBERTO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-387-6045
Mailing Address - Street 1:13330 BURBANK BLVD
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91401-5321
Mailing Address - Country:US
Mailing Address - Phone:818-387-6045
Mailing Address - Fax:818-387-6471
Practice Address - Street 1:13330 BURBANK BLVD
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91401-5321
Practice Address - Country:US
Practice Address - Phone:818-387-6045
Practice Address - Fax:818-387-6471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-24
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA32356208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA32356Medicare Oscar/Certification