Provider Demographics
NPI:1144540956
Name:NORTHRIDGE HOSPTIAL MEDICAL CENTER
Entity type:Organization
Organization Name:NORTHRIDGE HOSPTIAL MEDICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:BERTRAND
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RD
Authorized Official - Phone:818-885-8500
Mailing Address - Street 1:2200 COLORADO AVE
Mailing Address - Street 2:SUITE 538
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-3571
Mailing Address - Country:US
Mailing Address - Phone:310-770-1160
Mailing Address - Fax:
Practice Address - Street 1:18300 ROSCOE BLVD
Practice Address - Street 2:NORTHRIDGE HOSPITAL MEDICAL CENTER
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91328
Practice Address - Country:US
Practice Address - Phone:818-885-8500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-03
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA852519282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital