Provider Demographics
NPI:1760544134
Name:VALLEY GERIATRIC MEDICAL GROUP
Entity Type:Organization
Organization Name:VALLEY GERIATRIC MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:OSTERWEIL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-986-7908
Mailing Address - Street 1:4911 VAN NUYS BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-1716
Mailing Address - Country:US
Mailing Address - Phone:818-986-7908
Mailing Address - Fax:818-990-4662
Practice Address - Street 1:4911 VAN NUYS BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-1716
Practice Address - Country:US
Practice Address - Phone:818-986-7908
Practice Address - Fax:818-986-9308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2010-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA41240207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1588651905OtherDR. OSTERWEILS NPI
CAGR0044060Medicaid
CAW10962Medicare ID - Type UnspecifiedGROUP NUMBER
CAWA41240AMedicare ID - Type UnspecifiedDAN OSTERWEILS NUMBER
CAGR0044060Medicaid