Provider Demographics
NPI:1922487560
Name:RELIANCE MEDICAL MANAGEMENT, LLC
Entity Type:Organization
Organization Name:RELIANCE MEDICAL MANAGEMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN BRUCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-400-6396
Mailing Address - Street 1:PO BOX 2160
Mailing Address - Street 2:
Mailing Address - City:MOORPARK
Mailing Address - State:CA
Mailing Address - Zip Code:93020-2160
Mailing Address - Country:US
Mailing Address - Phone:818-718-2301
Mailing Address - Fax:818-718-2311
Practice Address - Street 1:13990 BEAR FENCE CT
Practice Address - Street 2:
Practice Address - City:MOORPARK
Practice Address - State:CA
Practice Address - Zip Code:93021-5022
Practice Address - Country:US
Practice Address - Phone:818-718-2301
Practice Address - Fax:818-718-2311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-28
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty