Provider Demographics
NPI:1205515632
Name:TARZANA PAIN AND WOUND CENTER
Entity type:Organization
Organization Name:TARZANA PAIN AND WOUND CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:YVETTE
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:JEHDIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-355-3460
Mailing Address - Street 1:18607 VENTURA BLVD STE 204
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-4173
Mailing Address - Country:US
Mailing Address - Phone:562-355-3460
Mailing Address - Fax:
Practice Address - Street 1:18607 VENTURA BLVD STE 204
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-4173
Practice Address - Country:US
Practice Address - Phone:562-355-3460
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-13
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty