Provider Demographics
NPI:1295937969
Name:FOUR SEASONS MEDICAL CLINIC OF ENCINO
Entity type:Organization
Organization Name:FOUR SEASONS MEDICAL CLINIC OF ENCINO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHANTE
Authorized Official - Middle Name:
Authorized Official - Last Name:AGUILERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-907-1213
Mailing Address - Street 1:16661 VENTURA BLVD
Mailing Address - Street 2:SUITE 405
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-1914
Mailing Address - Country:US
Mailing Address - Phone:818-907-1213
Mailing Address - Fax:818-907-1210
Practice Address - Street 1:16661 VENTURA BLVD
Practice Address - Street 2:SUITE 405
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-1914
Practice Address - Country:US
Practice Address - Phone:818-907-1213
Practice Address - Fax:818-907-1210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty