Basic Information
| Provider Information | |||||||||
| NPI: | 1689666265 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FURDIK | ||||||||
| FirstName: | VILIAM | ||||||||
| MiddleName: | JESUS | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1112 LINDEN AVE | ||||||||
| Address2: | 204 | ||||||||
| City: | GLENDALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 912013378 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8189722867 | ||||||||
| FaxNumber: | 8189722862 | ||||||||
| Practice Location | |||||||||
| Address1: | 255 E SANTA CLARA ST | ||||||||
| Address2: | 230 | ||||||||
| City: | ARCADIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 910067226 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6264477144 | ||||||||
| FaxNumber: | 6264477145 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/18/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P2900X | A53336 | CA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Pain Medicine |
No ID Information.