Provider Demographics
NPI:1003638982
Name:DYNAMIC FAMILY CARE LLC
Entity type:Organization
Organization Name:DYNAMIC FAMILY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:SOHEILA
Authorized Official - Middle Name:MOHSENI
Authorized Official - Last Name:ABYANE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:818-267-7960
Mailing Address - Street 1:121 W LEXINGTON DR STE L400A
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-2230
Mailing Address - Country:US
Mailing Address - Phone:818-334-9260
Mailing Address - Fax:
Practice Address - Street 1:121 W LEXINGTON DR STE L400A
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-2230
Practice Address - Country:US
Practice Address - Phone:818-334-9260
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-30
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)