1962459479 NPI number — VALLEY CLINICA MEDICA GENERAL MEDICAL CENTER INC.

Table of content: MARK BRIAN FRIEDMAN DPM (NPI 1639221450)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962459479 NPI number — VALLEY CLINICA MEDICA GENERAL MEDICAL CENTER INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VALLEY CLINICA MEDICA GENERAL MEDICAL CENTER INC.
Provider Last Name:
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Provider's Other Name Information

Provider Other Organization Name:
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NPI Number Information

NPI Number:
1962459479
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/26/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 564
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BEVERLY HILLS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90213-0564
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
213-637-2530
Provider Business Mailing Address Fax Number:
213-384-3373

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8646 WOODMAN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ARLETA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91331-6503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-901-9090
Provider Business Practice Location Address Fax Number:
818-901-9347
Provider Enumeration Date:
05/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CARRILLO
Authorized Official First Name:
JOSE
Authorized Official Middle Name:
L
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
213-739-3282

Provider Taxonomy Codes

  • Taxonomy code: 261QM1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: GR0076080 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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