Provider Demographics
NPI:1558920843
Name:LIBERTYMED HEALTH GROUP INC
Entity Type:Organization
Organization Name:LIBERTYMED HEALTH GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RIMA
Authorized Official - Middle Name:
Authorized Official - Last Name:VOSKANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-248-2000
Mailing Address - Street 1:900 W GLENOAKS BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91202-2664
Mailing Address - Country:US
Mailing Address - Phone:818-241-4129
Mailing Address - Fax:818-241-0472
Practice Address - Street 1:900 W GLENOAKS BLVD STE D
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91202-2664
Practice Address - Country:US
Practice Address - Phone:818-241-4129
Practice Address - Fax:818-241-0472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-10
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1285183269Medicaid
CA1053706234Medicaid