1003857434 NPI number — VALLEY VITA MEDICAL CENTER, INC

Table of content: (NPI 1003857434)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003857434 NPI number — VALLEY VITA MEDICAL CENTER, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VALLEY VITA MEDICAL 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:
6
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:
1003857434
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/29/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18607 VENTURA BLVD.,
Provider Second Line Business Mailing Address:
SUITE 206
Provider Business Mailing Address City Name:
TARZANA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91356-4144
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-758-8282
Provider Business Mailing Address Fax Number:
818-758-8286

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18607 VENTURA BLVD.,
Provider Second Line Business Practice Location Address:
SUITE 206
Provider Business Practice Location Address City Name:
TARZANA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91356-4144
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-758-8282
Provider Business Practice Location Address Fax Number:
818-758-8286
Provider Enumeration Date:
06/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GUROVICH
Authorized Official First Name:
YUZEF
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/CEO
Authorized Official Telephone Number:
805-910-0333

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: GR0090900 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: ZZZ02527Z . This is a "BLUE SHIELD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com