Studio 12

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

License

190361AN Issued in CA

Legal business name

STUDIO 12

Practice address

12406 Magnolia Blvd
Valley Village, CA 91607-2415

Phone

(818) 761-7374

Fax

(818) 761-7377

NPI assigned

Jun 4, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Alan W. Fiske

Title

Ceo

Phone

(818) 761-7374

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1180915200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1144422817",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12406 MAGNOLIA BLVD",
            "city": "VALLEY VILLAGE",
            "state": "CA",
            "postal_code": "916072415",
            "telephone_number": "818-761-7374",
            "fax_number": "818-761-7377"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12406 MAGNOLIA BLVD",
            "city": "VALLEY VILLAGE",
            "state": "CA",
            "postal_code": "916072415",
            "telephone_number": "818-761-7374",
            "fax_number": "818-761-7377"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STUDIO 12",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-04",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "FISKE",
        "authorized_official_first_name": "ALAN",
        "authorized_official_middle_name": "W.",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "818-761-7374",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "CA",
            "license": "190361AN",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brianna Rose Statman, LMFT
• Alexandra M Stein, MPT
• Maren Stein
• Elena Stelnikova
• Marina Stepanyan, DDS
• Studio City Urgent Care & Medical Center, Inc.
• Menachem T. Stulberger, M.A.
• Henry Alberto Suarez, DDS
• Meir Sultan, CM (CERTIFIED MOHEL)
• Keren Sussman

• Substance Abuse Rehabilitation Facility in Valley Village, CA
• Providers in Valley Village, CA by specialty
• Substance Abuse Rehabilitation Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.