Bodylogicmd of Encino P.C.

Primary specialty

SpecialistTaxonomy code 174400000X

License

A69979 Issued in CA

Legal business name

BODYLOGICMD OF ENCINO P.C.

Doing business as

BodyLogicMD of Encino

Practice address

16260 Ventura Blvd
Suite 105
Encino, CA 91436-2203

Phone

(877) 835-1536

Fax

(877) 835-1537

NPI assigned

Mar 27, 2009

Last updated

May 8, 2009By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Travis Deuson, M.D.

Title

Director

Phone

(877) 835-1536

Specialties & licenses 1

Addresses

Other names 1

• BodyLogicMD of Encino Doing business as

Locations

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

{
    "created_epoch": "1238112000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1241740800000",
    "number": "1780826396",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27023 MCBEAN PKWY",
            "address_2": "83",
            "city": "VALENCIA",
            "state": "CA",
            "postal_code": "913555145",
            "telephone_number": "877-835-1536",
            "fax_number": "877-835-1537"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16260 VENTURA BLVD",
            "address_2": "SUITE 105",
            "city": "ENCINO",
            "state": "CA",
            "postal_code": "914362203",
            "telephone_number": "877-835-1536",
            "fax_number": "877-835-1537"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BODYLOGICMD OF ENCINO P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-03-27",
        "last_updated": "2009-05-08",
        "status": "A",
        "authorized_official_last_name": "DEUSON",
        "authorized_official_first_name": "TRAVIS",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "877-835-1536",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "CA",
            "license": "A69979",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BodyLogicMD of Encino",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Specialist in Encino, CA
• Providers in Encino, CA by specialty
• Specialist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2009; 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.