Boulevard Pediatrics Medical Group Inc

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

A81091 Issued in CA

Legal business name

BOULEVARD PEDIATRICS MEDICAL GROUP INC

Practice address

16550 Ventura Blvd
Ste 414
Encino, CA 91436-2004

Phone

(818) 783-3110

Fax

(818) 783-3115

NPI assigned

Feb 28, 2007

Organization subpart

No

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

Authorized official

Name

Jeremy F Shapiro, MDNPI 1174660286

Title

President

Phone

(818) 783-3110

Specialties & licenses 1

Addresses

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jeremy F Shapiro, MD

  • Pediatrics Physician
  • Encino, CA
  • NPI 1174660286
  NPD (past) Authorized official
• Katrin Lalezarzadeh, D.O.

  • Pediatric Hospice and Palliative Medicine Physician
  • Encino, CA
  • NPI 1942414024

  Pediatrics

  NPD (past)
• Jena K Liddy, MD

  • Pediatrics Physician
  • Encino, CA
  • NPI 1942347059
  NPD (past)
• Helen Mitchell

  • Pediatrics Physician
  • Encino, CA
  • NPI 1245817774
  NPD (past)

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

{
    "created_epoch": "1172620800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1390348800000",
    "number": "1669509154",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16550 VENTURA BLVD",
            "address_2": "STE 414",
            "city": "ENCINO",
            "state": "CA",
            "postal_code": "914362004",
            "telephone_number": "818-783-3110",
            "fax_number": "818-783-3115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16550 VENTURA BLVD",
            "address_2": "STE 414",
            "city": "ENCINO",
            "state": "CA",
            "postal_code": "914362004",
            "telephone_number": "818-783-3110",
            "fax_number": "818-783-3115"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOULEVARD PEDIATRICS MEDICAL GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-28",
        "last_updated": "2014-01-22",
        "status": "A",
        "authorized_official_last_name": "SHAPIRO",
        "authorized_official_first_name": "JEREMY",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "818-783-3110",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "A81091",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Danielle Born-Nagel
• Victoria Borovsky, M.D.
• Carmen Julia Botero, M.D.
• Samantha Cobert Bothast, LCSW
• Chelsea Bou
• Boulevard Surgicenter, Inc.
• Natalie Rita Bouri
• Talin Bourian, FNP-C
• Sabrina Bouzaglou
• Lisa Ann Bove, LCSW

• Pediatrics Physician in Encino, CA
• Providers in Encino, CA by specialty
• Pediatrics Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.