Provider Demographics
NPI:1497161335
Name:VALLEY HOPE OUTPATIENT
Entity Type:Organization
Organization Name:VALLEY HOPE OUTPATIENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FERNANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:818-902-1100
Mailing Address - Street 1:14416 FRIAR ST
Mailing Address - Street 2:C
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91401-2199
Mailing Address - Country:US
Mailing Address - Phone:818-902-1100
Mailing Address - Fax:
Practice Address - Street 1:14416 FRIAR ST
Practice Address - Street 2:C
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91401-2199
Practice Address - Country:US
Practice Address - Phone:818-902-1100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-10
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA190803AP305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service