1508898545 NPI number — DR. DEBRA YERMAN CHOLODENKO D.C.

Table of content: DR. DEBRA YERMAN CHOLODENKO D.C. (NPI 1508898545)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508898545 NPI number — DR. DEBRA YERMAN CHOLODENKO D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHOLODENKO
Provider First Name:
DEBRA
Provider Middle Name:
YERMAN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
YERMAN
Provider Other First Name:
DEBRA
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.C.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1508898545
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/20/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17514 VENTURA BLVD
Provider Second Line Business Mailing Address:
STE 104
Provider Business Mailing Address City Name:
ENCINO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91316-3893
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-995-4300
Provider Business Mailing Address Fax Number:
818-995-4301

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17514 VENTURA BLVD
Provider Second Line Business Practice Location Address:
STE 104
Provider Business Practice Location Address City Name:
ENCINO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91316-3893
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-995-4300
Provider Business Practice Location Address Fax Number:
818-995-4301
Provider Enumeration Date:
07/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  12864 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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