1215960828 NPI number — SOUTH VALLEY HEART CENTER, INC

Table of content: (NPI 1215960828)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215960828 NPI number — SOUTH VALLEY HEART CENTER, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTH VALLEY HEART CENTER, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215960828
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/28/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 260602
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ENCINO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91426-0602
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-990-1445
Provider Business Mailing Address Fax Number:
818-990-1444

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16661 VENTURA BLVD
Provider Second Line Business Practice Location Address:
STE 820
Provider Business Practice Location Address City Name:
ENCINO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91436-1914
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-990-1445
Provider Business Practice Location Address Fax Number:
818-990-1444
Provider Enumeration Date:
07/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MANAVI
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
SHAHAB
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
818-990-1445

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00G698750 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00G69875 . This is a "BLUE SHIELD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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