Provider Demographics
NPI:1730944125
Name:CALIFORNIA BIRDIE HEALTH, P.C.
Entity type:Organization
Organization Name:CALIFORNIA BIRDIE HEALTH, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:BRUNO
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN TUYKOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-510-6956
Mailing Address - Street 1:820 BEAR TAVERN RD
Mailing Address - Street 2:
Mailing Address - City:EWING
Mailing Address - State:NJ
Mailing Address - Zip Code:08628-1021
Mailing Address - Country:US
Mailing Address - Phone:347-510-6956
Mailing Address - Fax:888-698-0847
Practice Address - Street 1:330 N BRAND BLVD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-2308
Practice Address - Country:US
Practice Address - Phone:347-510-6956
Practice Address - Fax:888-698-0847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-15
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty